Fear of concussions reshaping football

Regina and Harry Green (holding Isabella) worried about concussions when their older son, 10-year-old Harry(in gray shirt, next to Jake), wanted to play peewee football in Cherry Hill.
Regina and Harry Green (holding Isabella) worried about concussions when their older son, 10-year-old Harry(in gray shirt, next to Jake), wanted to play peewee football in Cherry Hill. (RON TARVER / Staff Photographer)
Posted: November 19, 2012

First in a series on concussions in sports.

Regina Green had her young and fearless days back when she played field hockey at Haddonfield High and at Georgetown. Once, she got slammed with a hockey stick to the face and needed 20 stitches. She went to a dance that night at her high school, proud to show off her wounds.

Now, she's a mother and a senior nursing administrator who deals extensively with acquired brain injuries, and phrases such as informed consent have entered her vocabulary. A friend who coaches peewee football in Cherry Hill lobbied for her 10-year-old to join the team - the boy was good at flag football, the children are all padded up, the helmets are better than ever, the coaches teach the right technique.

Regina was never anti-football. She loved watching her four brothers play the sport at St. Joseph's Prep. But there are all these stories of men who played in the NFL developing dementia, and that article in the New Yorker all but comparing the sport to dogfighting. Tales of suicidal ex-football players. Green thought of her son, and kept getting back to No!

It's not merely concussions that are a problem in football. Fear of concussions is a problem in football.

Does a weekend slip by without concussions making headlines? Last Sunday, Eagles quarterback Michael Vick left with a concussion, apparently after hitting his helmet on the turf. On the Fox halftime show during the Eagles game, Terry Bradshaw showed first-half "highlights" from other games - one highlight wasn't of a touchdown pass, but of San Francisco quarterback Alex Smith squinting while Bradshaw spoke of his "concussion-like symptoms."

That night, Bears quarterback Jay Cutler joined the discussion - the third starting quarterback of the day to leave a game and get a concussion diagnosis.

All told, seven players were knocked out of NFL games last weekend with diagnosed concussions.

If the subject seems omnipresent, it is. NFL commissioner Roger Goodell gave a speech Thursday at Harvard, titled "Leadership on the Road to a Safer Game."

Bradshaw himself went on The Tonight Show earlier this year and told Jay Leno that if he had a son, he wouldn't allow him to play football - "the fear of getting these head injuries is too great." Bradshaw said he suffered six serious concussions that knocked him out while he quarterbacked the Pittsburgh Steelers. He would do it again himself, Bradshaw added about his storied career, but he said football will "slowly phase away" as a major American sport, that soccer will eventually rise above it.

Is this merely hyperbole? Is it possible that the next Terry Bradshaw or Michael Vick might not even start playing the sport because of concussion fears? Could football go the way of boxing, moving toward the fringe as the risks continue to pile on the benefits? Are the lights starting to flicker on America's true sporting pastime?

Not likely, not any time soon. Experts point out that the potential NFL player pool is deeper than ever. Changes in injury protocols resulted from the fear over concussions after members of Congress publicly compared professional football to the tobacco industry. Those protocols have filtered to the youth level.

Jon Butler, executive director of Pop Warner football, based in Langhorne, said final numbers aren't in yet, "but our gut sense" is Pop Warner participation numbers are down this year nationwide due at least partly to fears of concussions, despite rule changes mandating less hitting in practice.

"Not trying to pass the buck," Butler said, but he notes more children suffer concussions riding a bike or skateboarding. Those injuries, however, aren't generally televised. Why not switch to flag football? Butler said his organization estimates at least 90 percent of Pop Warner players would drop out if a change were made to flag only. He knows, however, the fear that is out there - and also knows that when a Pop Warner team in Massachusetts inflicts five concussions in a single game, the story lands on the front page of the New York Times.

Meanwhile, more than 2,500 former NFL players are suing the league, arguing it deliberately concealed information about the effects of repeated hits to the head. The class-action suit could land in a Philadelphia federal courtroom as soon as January.

Risk and benefit

Fear can be debilitating. It also can be healthy. In past years, Vick and others may have tried to keep playing - and been allowed.

But the message of a safer game isn't being received. Doctors say that more than ever, the first question parents ask is: "Should my son play football?"

"I don't know how to answer that," said Harry Bramley, the medical director of Penn State's concussion program, who has a background as a pediatrician. "Everywhere in life, there's a risk and a benefit. Every kid I see, every family I see, has a background very specific to them. The risk ratio is very different. That's what takes time and effort, to help them understand that."

Bramley said doctors themselves are increasingly asking questions about the risk and benefits of football. "There clearly are some physicians who get nervous, I do hear that," he said.

Robert Cantu, codirector of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine and coauthor of Concussions and Our Kids, admits he is being deliberately provocative when he advocates that hitting not be allowed in football before age 14. Cantu said he isn't picking that age for a scientific reason. It's more or less to coincide with the start of high school. Cantu would prefer to see no hitting before then. He believes the accumulation of "sub-concussive" hits is a major contributor to brain injuries suffered by football players.

In his work trying to prevent brain injuries, Cantu is not trying to alleviate fear of concussions.

That fear is at an all-time high even among youth coaches and parents whose sons already participate in the sport.

"I think there's too much paranoia out there right now," said Kevin Guskiewicz, who directs the Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina and is conducting a long-term study of retired athletes.

Guskiewicz and Cantu were speaking at the same concussion symposium earlier this fall at Penn State. They've agreed to disagree, Guskiewicz said, on the issue of when to start playing contact sports.

"I think there's value in teaching kids how to prepare to tackle and block and do all those things at those younger ages when we're developing our motor skills," Guskiewicz said. "We develop our motor skills between about age 10 and 14. It's not that what you don't have after 14 you'll never get, but you stand a heck of a better chance of developing it and doing it right if you're developing it between 10 and 14.

"I just worry that if you eliminate that sort of activity prior to age 14, you're probably more at-risk for a serious injury."

Cantu strongly advocates a "hit count" for younger athletes, similar to a "pitch count" for young baseball pitchers that caps the number of pitches they are allowed to throw in a game or a set time. Cantu helped organize a hit-count symposium last month in Waltham, Mass.

"The technology exists to count hits," said Chris Nowinski, a former Harvard player and cofounder with Cantu of the Sports Legacy Institute, which has been instrumental in raising awareness of concussions in sports. "We should be monitoring exposure, and theoretically having limits to exposure."

Researchers talk of the "desperate need" for long-term risk assessment data. And parents of boys already playing find themselves in a real balancing act if their son does suffer a concussion. How susceptible is he to another? What are the long-term risks? How much discussion should there be without scaring him? How long should he sit out?

Andrew Brandt, newly appointed director of the Moorad Center for the Study of Sports Law at Villanova and a former NFL executive and agent, says that congressional pressure "jump-started a positive trajectory," and that decisions for NFL players to reenter games are now being made by medical professionals instead of coaches and the players themselves. Doctors are employed by teams during games, Brandt pointed out, but independent doctors are part of the procedure for allowing a player to return after a diagnosed concussion.

Brandt, who writes about the NFL for ESPN.com, said one often-overlooked aspect is that it is difficult "to protect players from themselves."

"I've seen so many players, especially fringe players - they know that they have to play," Brandt said. "Their concern is not long-term brain injury, it's the next game, the next contract. They're intentionally flunking baseline tests. Frankly, I don't know how you protect against that."

'Fear is always there'

Just before noon, hamburgers were on the grill and grade-school cheerleaders robustly yelled for 8- and 9-year-olds in a playoff football game in Colwyn. Nobody watching from the sidelines last weekend seemed to be shaking in fear of injury. A mother yelled, "Shake it off!" after her son went down and stayed on the ground for a moment.

However, when conversation turned to concussions, parents and even coaches in the Delaware County Youth Football League said they talk about it more than any other safety issue. Nobody was saying it was much ado about nothing.

"The fear is always there," said Ernest West, a coach with the West Philly Tar Heels. "Two years ago, parents would yell, 'He's fine. Get up. You're all right.' . . . Now, it's different, really in the last couple of years."

Durrell Davis, head of the Colwyn Comets, said that these days if a player gets hit, even if it's nowhere near the head, a parent might say, "Let me see your eyes."

There was one helmet-on-helmet hit - crashing helmets on 9-year-olds still make a jarring sound - and coaches immediately screamed for a flag.

After the Colwyn Comets prevailed on a late touchdown over the Tar Heels, Don Cave, a Comets assistant, talked about how, even though he isn't one of the assistants allowed to be on the field, he forgot the league rules - "I ran out there as a parent" - after his son went down earlier this year after a helmet-on-helmet collision.

"When I saw the hit, [concussion] was the first thing I thought about," Cave said.

It turned out that his son had a mild one, if at all, Cave said. It looked worse on the field, the father said, because his son also had the wind knocked out of him. But the 9-year-old was held out of practice for the next three weeks, and wasn't allowed to hit in practice the fourth week.

"It's a fine line - you just pray for the best," Cave said of having his son back out there. "As a parent, it's joy and pain."

And they'll reevaluate whether to keep him out there.

"Possibly, he might not play next year," Cave said.

'Give it a year'

Harry and Regina Green's boys in Cherry Hill were brought into the discussion about whether they should play. That discussion included talk of concussions and their impact.

"Scientists can make their proclamations, but as a parent I just don't see the unique benefit of football - as opposed to other sports - that justifies the unique risks," said Harry Green, who is a psychologist.

Their 10-year-old son, Harry, pressed the issue. It was the only sport he wanted to play - "You always say we need to exercise, eat healthy, so let me play!"

For all their fears, his parents didn't say no. They saw how much of a boost he got out of playing flag football. Their pediatrician was consulted. His advice: Give it a year, see how it goes.

Their son took in all the information, and the family's decision - agreed to by all - was: Let's wait a year and reconsider. Regina Green knows those 20 stitches from a field hockey stick didn't negatively impact her life. The whole thing is complicated, she said. The family still watches football. The father was at the Eagles game last Sunday.

The Greens' 9-year-old, Jake, watching the Eagles and Cowboys from home, told his mother of Vick's concussion, "Mom, it happens all the time, and they are fine and back in like two weeks."

Jake added that former NFL quarterback Kurt Warner "had about five concussions, and then decided to retire after the playoffs, so his concussions must've been worse. But really, Mom, everybody gets them, and if you only get a few, it's not a big deal."

Not scared off, but still racking their brains

Liam McGrath, a senior football player at Carnegie Mellon, points out that parents don't worry any less when children get older, and not just about concussions. He's been battling some shoulder troubles the last few weeks, McGrath said, and "my mom cringes when I talk about possibly returning next year for my extra season of eligibility."

McGrath, a former quarterback at Haverford High who now plays in the secondary, isn't an NFL prospect. He is an operations research and statistics major playing in Division III. He doubts fear of concussions "will deter kids from wanting to play football," and not only because it's hard to grasp the severe consequences of concussions - which he said are real.

"Those dangers are a long way off. . . . Even at my age, it's hard for me to really understand that trade-off," McGrath said. "I love playing football and it's a very important part of who I am. Fear of a concussion isn't going to prevent me from continuing to play. I think that is probably the case with most players who are already involved with football."

McGrath added, "The research we have now" - mostly on ex-NFL players involved in a faster, stronger game for long periods - "is from players who played during an era where concussions weren't treated with the care they are today. We could find out that by taking precautions and treating concussions properly, there isn't a need to avoid playing football."

- Mike Jensen

Contact Mike Jensen at mjensen@phillynews.com. Follow @Jensenoffcampus on Twitter.

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