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: Madness to Maddening
March 23, 2020
By Karissa Niehoff
NFHS Executive Director
March Madness took on another meaning for everyone in the sports world during the week of March 9 – a week like none other in the history of organized sports with the acceleration of the coronavirus (COVID-19) in the United States.
The Madness was not the bouncing of basketballs in arenas around the country. Instead it was organization after organization trying to determine the viability of continuing to operate – particularly after the suspension of the NBA season and the cancellation of the NCAA Division I Men’s and Women’s Basketball Championships.
And NFHS-member state high school associations were among those organizations faced with making decisions because the heightened state of the coronavirus pandemic occurred in the middle of state high school basketball tournaments across the country. While 13 states had completed their tournaments, the remainder were faced with tough decisions throughout the week.
By the end of that week, another four states were able to complete their girls and boys basketball tournaments – although all of these states had to impose extreme limits on the number of fans in attendance.
About two-thirds of our member state associations had to shut down their tournaments. At this point, 19 state associations have cancelled their state basketball tournaments, while 15 others have postponed or suspended their events, although the hope of completing them seems to fade with each passing day.
In addition to basketball, some states were in the midst of conducting ice hockey, gymnastics and swimming championships. While most of those sports championships, along with wrestling, were completed, some states were forced to suspend or cancel these as well.
Because of varying information from state health leaders, the Centers for Disease Control and Prevention (CDC) and state governors, some states were able to continue playing longer than others. Each state’s high school basketball tournament is one of the anticipated events of the year – particularly for residents in towns with schools playing for a state title.
From start to finish of state basketball tournaments in the 50 states plus the District of Columbia, more than one million fans trek to gymnasiums to watch these events. This year, however, many of these fans, along with about half of the 950,000 boys and girls who play high school basketball, were not able to experience March Madness.
And if this wasn’t enough, spring sports seasons and championships are at risk – mainly because schools are closed in many states, which means the discontinuation of school activity programs. The NCAA has cancelled all spring sports championships; and while state associations haven’t cancelled spring championships yet, athletics and activities programs are on hold for a set period of time – or indefinitely in some states.
While the loss of college and professional sports has an enormous impact on everyday life, considering that events surrounding the coronavirus affect some 19,500 high schools and 12 million participants in high school sports and performing arts activities, the impact on high school sports is perhaps even larger.
We support our 51 member state association leaders as they continue to work through these challenges. The loss of state basketball championships in many states is a sizeable financial challenge ahead as they work to continue to make state-level athletics and activities programs available.
On many occasions, we have written about the value of high school sports and activities. This month, we have witnessed the disappointment of thousands and thousands of players and fans who were not able to experience a state championship – many of whom were “going to state” for the first time.
High school sports is different from every other level of sport as these programs are a vital part of communities across our nation. Two weeks ago, when the doors were closed in many gymnasiums, it was confirmation of the desire and need for education-based high school sports and activities in the United States.
During this time of imposed social distancing, it is a time to step back and be thankful for these programs in our nation’s schools.
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.