Close up profile view of youth football player wearing helmet

TBI Risk Too Great in Youth Football

Everyone would agree that kids shouldn’t smoke, nor should they drink alcohol. These are not controversial positions. But now there’s a doctor in California who wants to add one more item to the list: playing football. If you’re thinking this is just the latest attack on the notion that boys should be allowed to be boys, you’re probably not alone, but you might want to hear what Dr. Bennet Omalu has to say on the subject.

Dr. Omalu has been investigating the effects of traumatic brain injuries in football players for the past decade. You might recognize his name—Dr. Omalu is portrayed by Will Smith in the film ‘Concussion’ slated to hit theaters on Christmas Day. Dr. Omalu’s work has generated a surge in scientific research on the long-term consequences of TBI, specifically demonstrating that even relatively moderate blows to the head that takes place in contact sports can lead to problems down the road. The evidence found in his and others’ work needs and deserves to be taken seriously.

Dr. Omalu, a forensic pathologist and co-founder of the Brain Injury Research Institute, first exposed the devastating consequences of the collisions and cranial impacts that are common in football in his 2005 paper, “Chronic traumatic encephalopathy in a National Football League player.” The National Football League (NFL) saw the paper as a direct threat and immediately attacked Dr. Omalu. That battle is the crux of ‘Concussion,’ as it puts the issue of TBI in football squarely back in the public eye. Once again, Dr. Omalu is leading the TBI discussion.

In a recent op-ed for The New York Times (published Dec. 7), Dr. Omalu argues that just as we restrict youth from smoking and drinking until they are of legal age, there should also be a legal age “when it comes to protecting the organ that defines who we are as human beings.”

“The repetitive head jarring that is part of high-impact contact comes with a very real risk of permanent brain damage,” writes Omalu. Even if there is no documented evidence of concussion or concussive symptoms, children who participate for several years in contact sports accumulate cellular injuries that cause a progressive degenerative condition known as chronic traumatic encephalopathy (CTE).

Chronic Traumatic Encephalopathy and Repetitive Traumatic Brain Injury

The only known cause of CTE is a repetitive traumatic brain injury. Symptoms of the disease fall into four broad categories:

  • Body symptoms such as headaches, nausea, dizziness, and sensitivity to light and noise.
  • Cognitive problems, including difficulties with memory and concentration and general mental “fogginess.”
  • Emotional distress involving sadness, depression, nervousness, and irritability.
  • Disturbed sleeping patterns (too much or too little) and difficulty falling asleep.

Research into CTE expanded considerably in the years following the publication of Omalu’s 2005 paper. In 2014, the PBS documentary news program Frontline reported that researchers at the Department of Veterans Affairs brain bank examined the brains of football players who played high school, college, or professional football. Out of a sample size of 101 players, nearly 80 percent showed signs of CTE. Dr. Ann McKee, the director of the bank and an expert in repetitive traumatic brain injury who was interviewed for the Frontline story, said “the longer you play football, the higher your risk.”

The problem when it comes to youth sports is that the risk can become real in a relatively short time. In 2012, a 17-year old Kansas boy who died playing football was found at autopsy to have an advanced case of CTE, even though doctors who performed a CT scan just weeks earlier had cleared the young man to continue playing the game he loved.

A 21-year old University of Pennsylvania lineman who committed suicide in 2010 was discovered to have early stages of CTE, which doctors believed he developed from thousands of sub-concussive hits that occurred after playing football for roughly a decade. He had never been diagnosed with a traumatic brain injury.

Concussions in Youth, High School, and College Football

How common are concussions in amateur football? Earlier this year researchers led by Dr. Thomas Dompier, of the Datalys Center for Sports Injury Research and Prevention in Indianapolis, Indiana published the results of their research into this question in the journal JAMA Pediatrics. They analyzed data from three resources that contained information on youth leagues (participants are 5 – 14 years of age) in six states, 96 high school programs, and 24 collegiate level programs. In total, over 20,000 athlete seasons (one athlete participating for one season) were examined.

Dompier and his colleagues reported that as many as 182,000 football players may suffer a traumatic brain injury each year—99,000 in youth football, 79,640 in high school football, and 3905 at the NCAA level. This breaks down to approximately one in 30 youth players, one in 14 high school players, and one in 20 NCAA football players over each year. Multiply that by several years and it is clear that a young person who plays the sport through college has a relatively high risk of experiencing at least one traumatic brain injury, and possibly several.

But this is not the whole problem. In a recent paper published in the journal Developmental Neurology, scientists at Purdue University stated that athletes participating in high-impact sports can experience hundreds of sub-concussive hits during a single season. Sub-concussive hits don’t actually produce an actual concussion—they may not hurt much and may go completely unnoticed—but those hits can add up and put the brains of teenagers at real risk.

Making The Game Safer

As a nation, we have been slow to recognize the damage caused by a TBI. This is not surprising—many of us grew up playing sports where the culture was one of “toughing it out.” We were never schooled on what actually happens when you sustain a traumatic brain injury: the brain literally bangs around in the skull, which is rough, not smooth, on the inside. Nerve cells are damaged, cerebral blood flow may be reduced significantly for over a month, and the blood-brain barrier, the brain’s mechanism for protecting itself from substances that might damage it, is disrupted, a condition that can continue for weeks or months. This is not about being tough, this is about self-preservation.

Going forward we need to come to terms with what science is telling us about a concussion or traumatic brain injury. This doesn’t mean we have to be anti-football, but it does mean we have to redouble our efforts to ensure that football is safe and children are not exposed to a significant risk of brain injury. Being pro-safety will have a ripple effect that can reach those at the top of the football chain—those who set policy for the NCAA and the NFL. If parents withhold their kids from playing, it signals that safety is a priority for fans of the game. And if the need to make the game safer reaches critical mass, the leaders of the NFL and college football will have to adopt new policies to reflect the change in our national consciousness. That change will then trickle down to high school, and pee wee football leagues across the country.

For now, it appears that we have reached the point at which brain science can no longer be ignored. We have Dr. Bennet Omalu and others like him to thank for that.

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