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.
Expert Teammates Fill Health Roster
January 2, 2020
By Rob Kaminski
MHSAA benchmarks editor
Teamwork is a necessity in athletics. The MHSAA has put together the beginnings of a solid roster to combat mental health ailments throughout schools in the state.
Among the experts listed on the MHSAA Mental Health Speakers Bureau are Christy Buck, executive director, and Cat Lanting, program coordinator at the Mental Health Foundation of West Michigan; and Brooke Buys, mental and behavioral health specialist and founder of BLND Health. They already are serving MHSAA schools in various capacities.
Through personal appearances, promotional videos and staff availability, both organizations emphasize the same strategy when tackling mental health issues: recognition and treatment from within the school buildings and districts.
“We wanted to create self-starting kits that anyone in the district can implement,” said Lanting. “We have in-person trainings and opportunities for students to get together – students talking to students – for high schools and for middle schools.”
Lanting coordinates the be nice.® Action Plan, founded by Buck. The plan calls for people to “notice, invite, challenge and empower” when recognizing changes in those close to them.
“It’s an attractive statement, but the key to the action plan is that it’s transferable. It can work from the pre-K level to senior citizens,” she said. “We want people to notice change, invite people into the conversation, challenge stigmas, and empower themselves with knowledge surrounding mental health.”
Buys, meanwhile, is one of a team of behavioral health specialists delivering messages to student-athletes around the state. Many of her associates in BLND (pronounced “blend”) not only talk the talk, but have walked the walk as collegiate athletes.
“The best course of action for administrators, teachers, coaches is to strive to build and maintain trust with the student-athlete; have genuine, non-judgmental conversations to include open-ended questions and authentic concern,” said Buys, who played soccer at Kalamazoo College.
Both be nice.® and BLND staff members made appearances at schools this year to assist in promoting recognition. A 90-second video produced by be nice.® was included in all MHSAA online rules meetings this year, featuring endorsements from University of Michigan coaches Jim Harbaugh and Carol Hutchins and Michigan State University coaches Mark Dantonio and Tom Izzo.
“When our team met with Mark (Uyl) and some athletic directors in Spring 2019, the room was filled with people who have just started to recognize mental health as an issue. The challenge was to deliver a 90-second video promoting the be nice.® Action Plan with a quick turnaround so it was ready for the fall rules meetings,” said Lanting.
She encourages people to visit be nice.org and “take the be nice.® pledge.”
“be nice.® started in 2010, and when people first see it they think, ‘bullying prevention,’ but really it is an action plan that is evidence-based,” Lanting said. “The be nice.® Action Plan can be used anywhere – in the workplace, community organizations – but schools is where we started and where we are currently having the most impact.”
Connecting with the most people possible is the goal across the board. Buys encourages schools to utilize the “one-stop shopping method” in the BLND programming.
“An external referral service that is qualified, efficient, dynamic, and integrated in nature – like BLND – helps provide a one-stop shop for student-athletes and parents to receive the support they need,” said Buys.
Lanting agrees, stating, “The more students and parents become familiar with some of the signs and symptoms, the better. Coaches and teammates might be the first to notice a change in someone’s behavior whether through daily interaction or social media activity.”
Buys and company have noticed a few recent trends leading to school-aged anxiety and stress, and have people in place to visit groups and lead discussions.
“The signs and symptoms can be very individualized, but some general factors may include isolation, irritability, drastic changes to an individual’s common mood or behavior,” noted Buys. “Students can also be affected by major life changes such as parent divorce, break-up with significant other, changing schools, things of that nature.”
When Lanting receives inquiries from individual coaches regarding the be nice.® program, she encourages them to get entire teams or districts involved, because, “it’s a K-12 initiative, and sports is really a great place to start.”
Sport participation offers a different set of variables. Student-athletes enjoy additional support and guidance, but there is a flip side.
“Student-athletes do have access to more adult guidance through coaches, and certainly enjoy inclusion as part of a team, but they also tend to be more at risk for anxiety,” Lanting said.
Buys points out several reasons for this, including added expectations – whether from within or from peers, parents and coaches. They are also busier than many others.
“Time management is an issue for all of us, but student-athletes can have difficulties finding that rhythm,” Buys said. “This can cause a lot of anxiety if an area of the athlete’s life that they value is perceived as not getting the attention it needs.”
Another source of stress more likely to affect athletes is injuries.
“One of the biggest challenges in the athlete population dealing with stress and anxiety is the strong relationship between stress and injury,” said Buys. “Susceptibility to injury as well as the length of time for recovery are affected by stress.”
Identifying physical conditions is much simpler than recognizing behavioral ailments. That’s why it’s important for groups like BLND and be nice.® to teach the school population to self-diagnose.
Lanting coordinated a be nice.® football game between Holland/Zeeland-area high schools last fall, and is planning a similar event during a Fennville-Saugatuck boys basketball game this winter.
“We see all the ‘pink-out’ games and events for other causes, and that’s great,” Lanting said. “But a person in high school is so much more likely to be affected by mental health than suffer a physical ailment. That’s why the student-led part of this is so important; they tell us when things happen that might trigger certain behaviors.”
PHOTOS: (Top) be nice. founder Christy Buck (left) and program coordinator Cat Lanting pose with MSU men’s basketball coach Tom Izzo during production of a promotional video this summer. (Middle) The BLND Health Detroit Metro Team, including founder Brooke Buys (seated middle, second row from bottom.)