Football: Is It Really a Surefire Death Sentence?
On February 13, 2023, Assembly Bill 734 was introduced to the California State Legislature, which proposed a total ban on tackle football programs for those under 12 years old. (1) Assembly Member McCarty introduced this bill in response to the disturbing increase in research literature suggesting a direct correlation between permanent brain damage and head impact from football. (2,3) In fact out of the 376 former NFL players autopsied, 345 players were diagnosed with chronic traumatic encephalopathy (CTE), a neurodegenerative disease. (3,4) This condition is characterized by dementia, depression, and memory loss as a result of repeated head injuries. (3,4) The first case of CTE was identified in 2005 by Dr. Bennet Omalu when he performed an autopsy on NFL Hall of Famer Mike Webster, who passed away at age 50. (5) Dr. Omalu’s findings led to the conclusion that Webster developed CTE from repeated mild traumatic brain injuries (mTBI) from football, which explains his loss of memory and severe depression towards the end of his life. (5) Shortly after the publication of this article, many other famed NFL stars, including Junior Seau, Charles White, and Aaron Hernandez, fell victim to CTE causing them to experience drug abuse, erratic behavior, and depression. (6–8) Due to these breakthrough findings, football has since been synonymous with traumatic brain injuries, hence causing a decline in youth football participation in recent years. (9) Since the original publication of Dr. Omalu’s article, significant strides have been made in football leagues of all age groups, including the NFL. These improvements prompted a profound cultural transformation both on and off the field, reshaping players’ perspectives on traumatic brain injuries. The shift from a “tough” culture, where players were expected to ignore pain, to prioritizing a player’s health has been evident. Rigorous protocols implemented by all football leagues aim to mitigate the negative long-term effects of TBIs. In addition, a proactive layer of protection has emerged through on-field cultural changes, through the adoption of safer tackling techniques and advancements in equipment. In light of the two-layered cultural shift taking place both on and off the field, it is important to reevaluate the assumption that traumatic brain injuries are inevitable in football.
Football players are traditionally viewed as “tough” players who do not show any sign of weakness or pain. This culture of toughness has been ingrained in football since the beginning of the sport and peaked from the 1960s until the early 2000s. During this period, every player on the team only had the goal of obliterating their opponent’s body, even if it meant sacrificing their health. The 1989 USC Trojans linebackers squad embraced this spirit since no one had any knowledge about the long-term effects of traumatic brain injuries. (11) For example, Scott Ross, a linebacker for the Trojans, would often ask his parents if his team won or lost right after games. (11) Craig Hartsuyker, another linebacker, would get concussions at the beginning of the game, play through the game, and end up in fraternity row, only to forget that he had played earlier that day. (11) Due to this culture, by 2023, five out of the twelve USC linebackers from the 1989 team had passed away and been diagnosed with CTE. (11) Examples like this did not only apply to the USC Trojans, as this was the norm throughout collegiate and professional football. (12) These narratives depicted football as a sport that promotes the sacrifice of personal health for the team, portraying football players as “tough” individuals who do not show pain. Hence even today, football has been associated with a culture of toughness, where players were expected to ignore their traumatic brain injuries as if they were just a part of the sport.
The assumption that football players today are expected to ignore traumatic brain injuries due to the “tough” culture of football is completely wrong. The shift can be reflected in the new 2011 NFL concussion protocol, which actively prevents players who have experienced TBIs from immediately returning to the field. (13) This protocol first addressed the player’s education on TBI, its importance, and its long-lasting effects on a person. (13) The primary purpose of this aspect of the protocol is to fight the old culture of ignoring symptoms of TBI by properly educating the players. (13) Following a blow to the head in a game, a player is immediately removed from the field and undergoes a neurological exam. (1) Depending on the results, the player can return to the field or be escorted to the locker room for further tests. (13) To ensure that every potential TBI is identified, the revised protocol introduced an additional athletic trainer spotter that watches the video replays to identify head injuries that could have been missed by the sideline athletic trainers. (13) This measure was implemented to ensure that every TBI is successfully identified to be treated. (13) Even if players attempt to hide or ignore it, the athletic staff can still catch the TBI through this new provision of the protocol. (13) In addition, variations of the official NFL concussion protocols have been adopted throughout the different football leagues, including youth, high school, and collegiate football. (14) For example in youth football, a player who has sustained any form of head blow is immediately taken off the field and can not return to the field until a licensed medical professional clears the child. (14) These updated, stricter protocols reflect a shift in football culture that emphasizes the well-being of football players, both on an elementary and professional level. However, the shift in football culture can also be seen through a protective layer to prevent traumatic brain injuries.
Many people assume that football players tackle by colliding with their opponents head-on, which causes many traumatic brain injuries. This was the case for all football players between 1960–2000 when they were taught to use their heads to run through opponents. (15) For example, Sheldon Brown, a Cleveland Browns cornerback, recalls that his couch always taught him to tackle by “running through like knives”, leading with their head. (15) This technique, known as spearing, was the norm for tackling throughout this era, as bigger players were only focused on using their strength to bring the opponent down by running into them. (15) However, this technique increased the chances of getting a TBI, as the first body part coming into contact is the crown of the head. (15) This tackling technique aligns with the “tough” football culture, as players ignore their well-being to tackle their opponents. When new rules were introduced in 2011 to change the tackling techniques to reduce TBIs, many football players and critics criticized the new rules, stating that the football culture had been ruined. (15) Hall of Famer Troy Polamalu defended the old tackling techniques, saying they instilled fear and made the players “men.” (15) Due to the reliance on the spearing tackling technique, many fans and critics associate football with traumatic brain injuries, as spearing increases the risk of not only TBIs but also cervical spine fractures. (16) However, since 2011, the tackling techniques have shifted dramatically due to new rules aimed at eliminating tackling from football.
The assumption that all tackling causes traumatic brain injury should be re-examined in today’s world of football, as tackling ten years ago looked a lot different than it does now. Rule changes implemented in 2011 changed tackling in the NFL, which also affected tackling in the collegiate, high school, and youth football programs. (17) The modern tackling form, similar to rugby tackling, emphasizes shoulder-first contact to avoid head blows. (18) Tacklers minimize the force exerted on their heads by positioning the head up and to the side of the hip of the ball carrier. (18) Many other rules have been implemented in the NFL to promote the adoption of improved tackling techniques. For example, lowering the head into the opponent’s helmet is now a personal foul. (19) Engaging in unnecessary contact like tackling kickers, punters, and quarterbacks when they do not have the ball is also now a foul. (19) This new tackling form significantly reduces the chances of the head experiencing any impacts, as the shoulder absorbs most of the impact. (18) A 2001 study showed that the rugby tackling form significantly reduced traumatic brain injuries compared to the then-more popular head-down tackling technique. (16) Another study involving an eleven-year-old youth football team found that training with a head-up tackling style reduced the severity of head acceleration, which decreased the chances of TBIs from occurring. (20) The advocacy for head-up, shoulder contact tackling within football leagues of all levels represents a cultural change on the field, actively reducing TBIs compared to the tackling form from two decades ago. Along with the change in tackling form, equipment advancements have also played a role in the active prevention of traumatic brain injuries on the field. This transition to a safer tackling technique underscores the overall shift towards prioritizing safety in football, as equipment technologies have also drastically improved.
Football helmets have drastically evolved within the last two decades to focus on TBI mitigation. First introduced in 1896, the original purpose of the helmet was to prevent skull damage and has gone through many different evolutions aimed at protecting the player. (22) Even with massive changes to the football helmet during the 20th century, traumatic brain injuries were still incredibly common throughout this period but were overlooked due to a lack of understanding of their long-term effects. (22) Hence, when the long-term effects of traumatic brain injuries were reported in the early 2000s, many people believed that football helmets could not prevent traumatic brain injuries. (22) However, recent helmet developments have shifted from focusing on skull injuries to now preventing traumatic brain injuries.
Every year, the NFL releases a Helmet Laboratory Testing Performance Result, which ranks helmets based on their ability to reduce the severity of head impacts. (23) Since 2017, VICIS helmets have been ranked the highest in the list, as the company is known within the football community for pioneering breakthroughs that addressed concussions. (23) By implementing a flexible outer shell concept, VICIS helmets absorb up to 90% of the force generated in an impact, preventing the force from negatively impacting the brain.24 A study showed that teams using VICIS helmets in Washington high schools had a 42% statistically significant decrease in concussions compared to years prior without them. (25) Advancements in helmet technologies, like those from VICIS, drastically reduced traumatic brain injury risks, challenging the notion that helmets are ineffective against TBIs. All thirty-two teams in the NFL now rely on VICIS helmets, and more recently, other major brands, including Riddell with the 2022 release of the Axiom, have adopted this flexible shell concept due to its proven results in TBI prevention. (27,28) By 2024, the top five NFL-recommended helmets all incorporate this concept, signaling the rapid adaptation of technology to safeguard players’ health. (23) The wide adaptation of this new technology in all major helmets highlights the technological evolution aimed at TBI mitigation. The multi-layered shifts in football culture have allowed the whole football community to acknowledge the long-term effects of traumatic brain injuries in football and continue to push for a reduction in TBIs in football.
Significant cultural shifts and technological advancements mark football’s evolution in mitigating traumatic brain injuries, thus challenging the foundational assumption that such injuries are inevitable in football. While recent legislative debates regarding youth football are hotly contested in many states, high school tackle football has still been experiencing a rapid decline in participation. (26,10) Fears that football and traumatic brain injuries are inherently linked are the main driving force for this declination in overall youth football participation. However, the cultural shift towards emphasizing player health within the football community over the last decade resulted in a multi-layered strategy to address TBIs both on and off the field. Advancements in helmet technology and safer tackling, along with stricter medical protocols, mitigate TBIs and their long-term effects. As Dr. Omalu once pointed out, Americans only worship two things — God and football. From beloved traditions of homecoming in high school to Thanksgiving matchups in the NFL, football has solidified its position within the tapestry of American culture. As the sport continues to hold an important place in American culture, the well-being of athletes must be prioritized to ensure the sport’s longevity. Football now stands at a crossroads, where the old culture of “grit” and “toughness” collides with the new emphasis on player safety. By embracing a multi-layered approach, football charts a course toward a safer future defined by the steadfast commitment to player safety.
References
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