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: 'New Normal' Sportsmanship

May 20, 2020

By Karissa Niehoff
NFHS Executive Director

The “new normal” is one of the many terms we hear repeatedly as the country begins its return to normal activities from the COVID-19 pandemic. Keeping six feet apart from other people, wearing a mask and frequent washing of hands are three of those important warnings.

And then there is the new “no-no” that cuts at the heart of high school sports – the handshake. Shaking hands has been a part of our culture for centuries and a mainstream of high school sports forever. It is hard to imagine high school sports without handshakes.

In addition to emotional displays among team members involving handshakes, high-fives and hugs, the handshake has been a way of demonstrating good sportsmanship toward the opponent.

In wrestling, for instance, shaking hands before a match is actually a part of the rules, which, of course, will have to be relaxed for the coming season. There are handshakes at the coin toss in football and before the opening jump ball in basketball.

After a hard-fought, back-and-forth tennis match, players meet at the net to shake hands – congratulating each other for their efforts. The actions are the same after golfers battle each other for 18 holes – removing the cap and shaking hands. 

These age-old practices demonstrate respect for the opponent, and in the case of post-game handshakes, graciousness in victory or defeat. 

The emotions in high school sports are often off the chart, with end-of-game celebrations by players, coaches and fans involving handshakes, high-fives and hugs. So, as the early phases of return to sports occur this fall, how do we meet social distance guidelines and continue to exhibit emotions and emphasize sportsmanship, which typically have involved touching between individuals?

While the social-distancing and no-contact guidelines are necessary – at least for the short term – to diminish the spread of the virus, they should not dampen the enthusiasm and emotion by everyone involved with high school sports. We hope these types of restrictions will be lifted at some point down the road, but for now, this is our “new normal.” 

The absence of these time-honored ways to express respect for the opponent does not diminish the importance of displaying sportsmanship in high school sports. In fact, we believe concern for fairness and displays of kindness, respect and graciousness will be more pronounced once high school sports resume; however, the methods of sharing these feelings will be different. 

Although perhaps not as endearing as a handshake, high-five or hug, there are other ways to express these feelings and emotions – for the opponent as well as teammates.

Some alternatives to consider are a slight bow with the palms pressed together, an air high-five, a smile and quick wave, a double-tap of the right hand across the heart and a wink with the thumbs up. Certainly, there are other possibilities – in fact, teams could develop their own methods for demonstrating sportsmanship to their opponents and celebrating big plays or victories with teammates. Through their resilience and great spirit, we look forward to how the millions of participants in high school sports and activities will accept this challenge.

There will be many concessions necessary to resume athletic competition, and shaking hands is one that must cease – at least for now. However, let’s view this change as an opportunity to find new ways to showcase sportsmanship in high school sports.

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.