![](/sites/default/files/imported/Photos/Daily/2019_NFHSVoice.jpg)
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.
![](/sites/default/files/imported/Photos/Daily/2019_NFHSVoice.jpg)
NFHS Voice: Source of HS Playing Rules
November 12, 2019
By Karissa Niehoff
NFHS Executive Director
When it comes to writing playing rules for major sports in the United States, it’s all in the acronyms. In football, you have the NFL, NCAA and NFHS. In basketball, it’s the NBA, NCAA and NFHS. In baseball, the rules-makers are MLB, NCAA and NFHS.
While the NFL, NBA, MLB and NCAA can be used on first reference without explanation, many people are unfamiliar with the NFHS. And yet the NFHS has been around as long – or longer – than the other four major sports organizations.
In many cases, references to NFHS rules – not only in these three major sports but the other 14 sports for which the organization writes rules – are simply noted as “high school rules.” The reality, however, is that the NFHS – the National Federation of State High School Associations – has been the national organization most directly focused on sports playing rules in the past 90 years since it published its first Football Rules Book in 1932.
With almost eight million participants in high school sports, NFHS rules are written for more individuals than all other levels of sports combined. As a result, risk minimization and the fundamentals of good sportsmanship are paramount to the rules-writing process for the NFHS and often are the distinguishing factors from rules at the higher levels of the sport.
Perhaps football is the best example of the commitment to risk minimization. In the mid-1970s, the NFHS was at the forefront of change when it outlawed spearing in high school football. The 1976 rule revision changed the landscape of high school football from an injury standpoint – from a high of 36 direct fatalities in 1968 to an average of about two per year by 2018.
Some people have questioned why there are multiple rules codes for a sport. Very simply, NFHS rules for high school play must be different than at the college and professional levels.
As an example, while professional baseball is concerned with how fast a baseball exits the batter’s box (Velocity Exit Speed) and how far the ball travels on a home run, the NFHS has enacted bat standards during the past 20 years to reduce the speed of balls coming off aluminum bats. In wrestling, the NFHS has enacted strict weight-management plans to reduce the risk of health issues. In ice hockey, while fighting is an accepted part of the sport at the professional level, NFHS rules have strict rules prohibiting all forms of unsportsmanlike conduct. In football, NFHS rules do not permit the excessive celebration displays following touchdowns that occur during NFL games.
In addition to risk minimization and sportsmanship, the NFHS must also weigh financial implications for schools when considering equipment and uniform changes. With schools ranging in size from less than 100 to more than 5,000 students, decisions must be made for the masses and cannot put undue financial hardships on schools.
NFHS rules are also written with the understanding that appropriate behavior begins with the coach, who is responsible for ensuring that his or her team exhibits good sporting behavior. Many penalties for unsportsmanlike conduct on the team are first directed against the coach.
While the NFHS and its member state associations govern the high school place in various sports – not only with playing rules but other issues as well – we maintain relationships with the National Governing Bodies (NGBs) in these sports to assist in meeting the needs of all participants.
Last week, the NFHS hosted a summit of various leaders of NGBs in Indianapolis. Leaders from about 15 NGBs were set to meet with NFHS staff to discuss various initiatives and opportunities for collaborative programs. We hope this is the first of many such meetings as it is crucial that all levels of sport work together to ensure ongoing opportunities for all sports participants.
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.