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.
Minding Our Business: Focus on Mental Health
December 30, 2019
By Mark Uyl
MHSAA Executive Director
For as long as I can remember, rules have played an important role in my life.
My father officiated high school and youth sports. So my brother and I did the same, and were fortunate enough to earn the right to work contests at the collegiate level. Today, my sons are officiating high school and youth sports.
I was hired by the MHSAA as an assistant director in large part due to my officiating background. Rules and regulations remain the backbone of athletics specifically, and society in general, as I learned more acutely when I entered the working world as a teacher and coach, then school administrator.
What also became abundantly clear to me within that framework was that it is our responsibility to provide our students not only the opportunity for competition, but also for our games and practices to take place under the safest conditions possible. From preseason physicals to equipment inventory and facility maintenance, a premium was placed on the well-being of participants and spectators.
Throughout my time at the MHSAA, various initiatives continued to target the growing list of health and safety concerns. My predecessor, Jack Roberts, often pointed to the “4 Hs” of the MHSAA’s health and safety campaign: Health Histories (Physicals), Heat and Hydration, Heads, and Hearts. Those pillars still hold the bulk of the content and resources on the Health & Safety resource pages of MHSAA.com. A few years ago, an extensive section promoting multi-sport participation was developed as an increasing amount of overuse injuries among single-sport athletes was being reported.
This fall, another section has been added as a sub-category to “Heads.” While attending an NCAA meeting in the summer of 2017, the topic of concussions came up, which I assumed to be the No. 1 issue concerning health and safety of student-athletes. It was quickly pointed out that student mental health – not concussions – had become the top health concern among our young people. That knocked me back.
Medical personnel have determined that depression, anxiety and other issues related to mental health are the No. 1 concern among adolescent-age children. There’s a real opportunity to provide some leadership and guidance in this area.
We need to offer resources on the subject, and also be prepared to provide guidance for our membership. The MHSAA has developed a Mental Health Speakers Bureau (please visit our Health & Safety page online). The first statewide Student Mental Health Summit scheduled for Lansing in October provided an opportunity for school principals, counselors, student leadership advisers and student leaders to convene on the topic.
The gathering was quickly sold out, indicating not only the growing nature of concern for this issue, but once again displaying the willingness of our educational leaders to recognize and react to another challenge.
This week, Second Half will publish the latest benchmarks report on the MHSAA’s mental health initiatives and those being undertaken by other states as well.