NFHS Voice: No HS Football Link to CTE
October 21, 2019
By Karissa Niehoff
NFHS Executive Director
When it comes to the long-term effects of concussions in sports, there is a wide range of information published – almost on a daily basis. Unfortunately, much of the media coverage as it relates to high school sports – and particularly the sport of football – is misleading.
Last week, the Concussion Legacy Foundation introduced its new public-service announcement that compared youth football dangers to smoking. As the pre-teen football players puff on cigarettes, the voiceover says, “Tackle football is like smoking, the younger I start, the longer I’m exposed to danger.”
The “Tackle Can Wait” campaign by the foundation is an attempt to steer children under the age of 14 into flag football. Although establishing a finite age may be difficult, reducing contact at youth levels is certainly a positive. USA Football is doing just that nationally through its Football Development Model. Likewise, the 51 member state associations of the National Federation of State High School Associations (NFHS) have enacted limitations on contact during preseason and practice sessions.
Our concern is the term “exposed to danger.” These types of messages continue to spread unwarranted fear to parents of high school student-athletes. The “danger” refers to reports that players who incur repeated concussions can develop chronic traumatic encephalopathy (CTE).
A 2017 study from the Journal of American Medical Association (JAMA) linked CTE in the brains of deceased National Football League players. Even if this report is accurate, these are individuals who endured repeated blows to the head for 20 to 25 years BEFORE any concussion protocols were in place.
Less publicized is a study by Dr. Munro Cullum and his colleagues at the Peter O’Donnell Jr. Brain Institute, which is a part of the University of Texas Southwestern Medical Center in Dallas. Cullum’s group studied 35 former NFL players age 50 and older who had sustained multiple concussions throughout their careers. The findings showed no significant association between the length of the individuals’ careers, the number of concussions and their cognitive function later in life.
Two studies, two different conclusions. Regardless of the outcome, however, they are not applicable to kids playing football before and during high school. There is absolutely no linkage to CTE at these levels, and the word “danger” should not be a part of the discussion.
A more applicable and significant study was also published in JAMA in 2017. In a study of about 4,000 men who graduated from Wisconsin high schools in 1957, there was no difference in cognitive function or decline between those who played football and those who did not as they reached 65 years of age. We would assume the majority of these individuals discontinued football after high school.
With more than one million boys – and girls – playing the contact sport of football each year, severe injuries do occur from time to time, but parents should know that efforts to lessen the risk of a catastrophic injury, including head injuries, have never been stronger than they are today.
In fact, new data from the National High School Sports-Related Injury Surveillance Study indicates some positive trends in concussion rates. The study, which was released in the American Academy of Pediatrics online issue of Pediatrics last week, indicated that concussion rates during football practices dropped from 5.47 to 4.44 concussions per 10,000 athletic exposures between the 2013-14 and 2017-18 seasons.
In addition, repeat concussion rates across all sports declined from 0.47 to 0.28 per 10,000 exposures during the same time period.
Concussion laws are in place in every state. All NFHS sports rules books have concussion management protocols. Helmet-to-helmet hits are not allowed in football. Limits on contact in preseason and practice in football are in place in every state.
After considering all the available research, we encourage parents to let their kids play their sport of choice in high school, but we would discourage moving away from football – or any contact sport – solely based on the fear of developing CTE later in life.
Dr. Karissa L. Niehoff is in her second year as executive director of the National Federation of State High School Associations (NFHS) in Indianapolis, Indiana. She is the first female to head the national leadership organization for high school athletics and performing arts activities and the sixth full-time executive director of the NFHS, which celebrated its 100th year of service during the 2018-19 school year. She previously was executive director of the Connecticut Association of Schools-Connecticut Interscholastic Athletic Conference for seven years.
NFHS Voice: Planning with Patience
May 30, 2020
By Karissa Niehoff
NFHS Executive Director
For several weeks, Americans have been awaiting answers to several questions. When will restaurants restart dine-in services? When will hair salons and gyms be open? When will people be able to congregate for worship services? And, of course, when will education-based sports and performing arts programs return?
And the answer to the all-important last question is the same as the first three – it varies from state to state.
If there was ever any doubt about the popularity and interest in high school sports and performing arts – and how much these programs have been missed during the past three months – it was erased last week as the NFHS released its Guidance for Opening Up High School Athletics and Activities document.
The response was non-stop through the mainstream media as well as our social media platforms as the first nationwide discussion about the return of high school sports and other activities was in full swing.
Since that disappointing week in mid-March when it seemed like all of life came to a halt, millions of people – from high school students, coaches, parents, administrators, officials and fans – have been looking forward to the return of school-based sports and other activity programs. And the guidance document offered some hope that soon the light at the end of tunnel will not be the oncoming train we have felt for many weeks.
Now, state high school associations are developing timetables and protocols for return of activities in their states. And those guidelines will be different from state to state. This is not a one-size-fits-all plan. Depending on the specific circumstances of a state with respect to the containment of the virus, its progression through the various phases of returning to activities could be much different than another state.
As the guidance document developed by the NFHS Sports Medicine Advisory Committee noted, our hope is that students can return to school-based athletics and activities in any and all situations where it can be done smartly. When it comes to education-based sports and performing arts within our nation’s schools, nothing is more important than the health and safety of the participants AND the individuals conducting those programs.
Some individuals have expressed concern that our guidance document is too cautious, noting that some non-school youth programs have already restarted in some areas.
In one state this past week, a non-school sports program was allowed to restart because the “data shows children are less affected by the coronavirus.” While the preponderance of evidence shows that to be true, plans in education-based activities will include also protection for adults who coach, officiate and administer those events, which may be seen as a more conservative approach.
Within high school sports, the drive of coaches and dreams of parents cannot run ahead of player safety. Last week, a successful high school football coach with three previous state titles was suspended for allegedly holding practices. And there have been reports of parents considering moving to another state with fewer COVID-19 cases to enhance the chance of their son playing football and earning a college scholarship.
The NFHS, through its Sports Medicine Advisory Committee, took action in developing its Guidance for Opening Up High School Athletics and Activities document. The various state high school associations are taking action in the coming weeks in developing plans for a return to activities at the state level.
Now, we would ask parents and other fans to take action – and that action is patience. The urge to return to normal is understandable, but the path back to where we were three months ago will take time, and that “time” will not happen at the expense of the safety and well-being of everyone involved in high school sports and performing arts programs.
Dr. Karissa L. Niehoff is in her second year as executive director of the National Federation of State High School Associations (NFHS) in Indianapolis, Indiana. She is the first female to head the national leadership organization for high school athletics and performing arts activities and the sixth full-time executive director of the NFHS, which celebrated its 100th year of service during the 2018-19 school year. She previously was executive director of the Connecticut Association of Schools-Connecticut Interscholastic Athletic Conference for seven years.