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With A Spike In Brain Injuries, High School Football Faces Questions About Safety

The Educated Reporter is taking a brief summer hiatus, and will return Wednesday, Aug. 8. For the next few days you’ll have a chance to catch up on some past posts. 

The  National Center for Catastrophic Sports Injury Research is reporting an increase in catastrophic brain injuries among high school football players, raising questions about whether recent changes to safety protocols are enough to protect young players, and if the game is worth the risk.

According to the center’s annual report, 13 high school football players sustained catastrophic brain injuries in 2011, up from nine in the prior year. The injuries included subdural hematoma requiring surgery, as well brain trauma resulting in strokes and comas. In most of the cases, the players had not fully recovered.

There was an average of five catastrophic brain injuries among high school players between 1992 and 2001, but that 10-year average jumped to 8.2 for the years 2002-11. Fred Mueller, director of the center at the University of North Carolina and the report’s lead author, told the Raleigh News & Observer that the jump “is a major problem.”

The center makes specific recommendations for continuing to improve the safety of high school football, including the proper execution of blocking and tackling. Pre-season physical exams are advised for all student players, and coaches and athletic trainers must make sure helmets fit properly. Another recommendation – have a physician on the field to assess players in the event of an emergency.

“I think a part of it is that we are educating people better, and injuries that might not have been reported in the past are being reported now,” Bob Colgate of the National Federation of State High School Associations told the News-Observer. “But we also have a responsibility to keep emphasizing that the head has to be taken out of tackling and blocking.”

The total number of young players seriously injured each year represents just a tiny fraction of the estimated 1.1 million high school students who play football. But that doesn’t negate the seriousness of the injuries or the potential benefits of learning from the statistical data.

To be sure, football safety is under intense scrutiny from Pop Warner leagues to the NFL. Each year there are about 67,000 concussions among high school players, a figure researchers say would top 100,000 if more of the head injuries were properly diagnosed and reported.

And there could be more to fear than just one unlucky hard hit. Recent studies have found football-related head trauma – even injuries that might once have been considered minor – can result in long-term health problems, particularly when players have successive concussions. A new study by Purdue University researchers, looking at high school football players over a two-year period, suggests that repeated hits over time, and not just one massive blow, cause concussions.

Over the past decade, emergency room visits for children and adolescents with sports-related traumatic brain injuries has jumped 60 percent, according to the federal Centers for Disease Control and Prevention. The most common injuries were among football players, with an incident rate of 0.47 per 1,000 athlete exposures. The second-place finisher for riskiest sport? Girls’ soccer, with an incident rate of .36 per 1,000 athlete exposures. (And those are just the figures from the emergency rooms, and don’t include injuries diagnosed by private physicians or neighborhood clinics.)

After a weekend of particularly brutal collisions among NFL players in 2010, Michael Sokolove, a contributing writer to the New York Times Magazine,asked “Is it morally defensible to watch a sport whose level of violence is demonstrably destructive? … What if the brain injuries are so endemic — so resistant to changes in the rules and improvements in equipment — that the more we learn the more menacing the sport will seem? Where will football, and its fans, go from there?”

I asked Sokolove for his take on the new report on brain injuries among high school players, and he said he was surprised the numbers had gone up given the increased focus on improving the safety of the game. He wondered if greater awareness of the risk of concussion, along with better methods to recognize the subtleties of the symptoms, might be a factor.

“It’s a difficulty injury to diagnose – there’s no broken bone you can see on an X-ray,” Sokolove said. “In the past the phrase people used was you `got your bell rung.’ The coach said you were OK, and they pushed you back out on the field. Clearly, there’s less of that happening, and that’s a good thing.”

While football gets the most attention, the safety protocols for other high school athletics – particularly girls’ soccer – also need scrutiny, said Sokolove, author of three books, including “Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women’s Sports.”

Keeping young players safe requires diligence among coaches and trainers to follow recommended protocols, Sokolove said. That would include cognitive testing and clearance by doctors before an athlete with a suspected concussion returns to play and, where possible, even preseason cognitive testing to establish an athlete’s baseline, Sokolove said.

“Everyone has to pay attention to these things,” Sokolove said. “And every parent has to be aware of them. If the protocols aren’t being adhered to, the parents have to step up.”

Sokolove’s discussion of the ethical dilemma posed by watching football was focused on professional players for whom the level of contact and potential for harm is arguably higher. But given the relative risk of injury that comes with high school football, should there be a similar discussion of the ethics of supporting the game, particularly as a school-sponsored activity?

High school football is too deeply ingrained in the nation’s fabric to ever be entirely eliminated, Sokolove said. So then the question is how to make it safer for players, something he said will be hard to do when many school districts and community teams lack the certified trainers and experienced coaches. Had any of his own children wanted to play football, Sokolove said he would have tried to talk them out of it.

“It’s never going to be entirely safe — that’s difficult to do when the culture of football is about toughness,” Sokolove said. “It’s a destructive sport. It’s a great sport, and I still watch it. But I can’t defend it.”

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