It’s a dilemma hundreds of thousands of New Jersey parents have struggled with over the years: If my young child plays tackle football, do they really risk brain damage?
The answer is “yes,” at least for kids under age 13, regardless of their medical history or sports experience — according to Dr. Christine Greiss, director of the JFK Johnson Rehabilitation Institute Concussion Program, part of the Hackensack Meridian Health network.
Several states, including New York, are considering bills to ban youth football, she said, and a measure has been introduced in New Jersey to prohibit kids under 12 from playing tackle. Opponents suggests the bills are overkill, or should extend to other sports as well. And public opposition and political challenges make the bill’s passage unlikely in the Garden State, at least in its current form.
But in an article published in June, Greiss argued that there is now abundant research to show that multiple blows to the head cause brain damage, even if they don’t always lead to concussions, and children’s brains are particularly at risk. There is no “safe level” of impact from tackles or other forces, she noted, and these blows have been linked to learning, memory, psychological, and social problems in individuals as young as their teens.
“We live in an era in which we advise our children to wear seatbelts, limit screen-time, and count calories. Moreover, we have become sharpened on determining the appropriate age for drinking, tobacco purchase, and driving,” Greiss wrote in the PM&R Journal, a publication of the American Academy of Physical Medicine & Rehabilitation.
Putting kids’ brains at risk
Given the importance of cognitive capacity and its role in determining a child’s success, she added, “it would be calamitous to put such a valuable and irreplaceable organ, this child’s brain, at risk by allowing him to participate in football at the age of 13. After all, he only has one.”
Although concern about head hits in football and other sports is not new, the issue has received greater attention in recent years as scientists have drawn more definitive links between these blows and brain damage, in particular chronic traumatic encephalopathy (CTE), a progressive degenerative disease that can only be diagnosed in a brain autopsy. Nationwide, more than 2 million children between the ages of six and 14 play tackle football, including upward of 25,000 in New Jersey.
CTE was first diagnosed by Dr. Bennet Omalu through his autopsy of 50-year old pro-football player Mike Webster, a tale told in the 2015 movie “Concussion.”
Omalu faced significant pushback from the National Football League and other sports organizations, and Greiss said coaches, former players, and some parents continue to raise questions about the research.
How many blows to inflict damage?
That difference of opinion also continues among experts, to some degree. In a corresponding viewpoint published with Greiss’s piece in PM&R, Dr. Scott Laker of the University of Colorado argues that benefits outweigh the risks when it comes to youth football. Laker contends that there is not adequate science yet to bar all kids from the game, since it’s not clear who is most at risk or how many blows it takes to actually cause damage. Others insist it is far safer to learn proper play early and, for some players, sports remain an essential route to higher education or economic security.
That opposition is well known to New Jersey Assemblywoman Valerie Vainieri Huttle (D-Bergen), sponsor of the proposal (A-3760) to ban those under 12 from organized or school tackle football programs. She ran into some opposition from youth coaches and other sports officials — as well as fellow lawmakers — when she introduced the measure earlier this year.
“It’s hard to challenge the football culture. It’s like going against the American sport,” said the assemblywoman, who has also backed legislation to strengthen protections for student athletes who do suffer concussions. “But more and more evidence is showing these head injuries are going to cause problems.”
Vainieri Huttle said she hopes to revisit the issue later this year with a revised bill that provides parents more options for how to protect their children. She envisions a law that requires education for parents on the true dangers involved in football, or perhaps requiring them to sign a disclaimer to allow those under 12 to participate.
Greiss has encountered the same arguments and supports Vainieri Huttle’s bill as it is. In fact, she would prefer the ban to apply to those under 13, or even 14-and-under. Youngsters are particularly at risk because, with their brains still developing, there is more space between the organ and the skull, which gives the brain more “shaking room” and therefore more opportunity for harm, she said.
In addition, Greiss said younger children are less likely to recognize the signs of a concussion and understand the potential danger involved. Symptoms of a concussion include headache, nausea, dizziness, light sensitivity, blurry vision, sluggishness, and memory problems. Anyone exhibiting these symptoms should be urged to get medical help immediately and may be required to rest for weeks if not months until their brains can recover, she said.
Brain damage without concussion
But brain damage can result even without a concussion, Greiss warned. “Subconcussive” blows — those not strong enough to cause a concussion — can still cause physical and behavioral changes in the brain that can trigger problems for youngsters, even after a single season. These blows come during practice, not just during games, she added, and there’s no way to assess how much is too much.
“We do not have a ‘magic number’ reassuring this athlete that he will not develop CTE if he avoids hitting his head more than ‘X’ amount of times,” Greiss wrote. “Even when good coaching, team culture, and modified technique are implemented, it is nearly impossible to standardize these well-intentioned ‘changes’ in football,” enough to truly protect children.
Other sports also involve risks of head injury, Greiss added, but soccer, baseball, and track don’t involve repetitive blows the skull. “American football is a collision sport in which head impact is a routine occurrence,” she wrote, and even a child with a bright future may face behavioral, developmental, and educational problems as a result of the game.