So obviously with the emerging science and data on how widespread CTE and related brain damage is it is important to conduct as many rigorous and widespread studies on this to really as a population see the true risks and rewards of saw Pop Warner or Pee-Wee football, or should the rules be further modified at all levels or just youth leagues?
This is an important step, and as the article lays out there are sincere points for both sides so we will have to see and track this. Personally having grown up the son of a professional sailor and taken many a blow on the water myself and developed a healthy respect for safety equipment and proper form if a child of mine did want to play football today I would probably say yes, maybe not as young as possible, but I think by Middle School most likely.
Comments
I have helped coach 6 and 7 year olds play micro tackle football the last two years. My experience has been that at that age, any other sport without a helmet is more dangerous. You'd be surprised at how receptive the young kids are to learning form tackling at that age. However, I do wonder about the safety of the slightly older kids; they deliver much more pop but still have weaker necks and other joints. I'd still say head to head collisions in non contact sports are more likely to cause a serious injury though.
Ive personally woken up in the water, out of the boat, with a nice bloody gash on the forehead because I was a dumb kid not paying attention doing something ive done 10's of thousands of times. And then head met the aptly named Boom(the horizontal spar attached to the bottom of a sail that can swing across the boat with great force) and i ended up in the hospital overnight. And I think we can say Sailing is one of the least traditionally "contact" sports there is.
I think in general any study that expands the data set and our knowledge of how our brain is impacted by outside trauma, especially in youth regardless of the activity that introduces it is important. There is just so much we still are discovering.
This isn't a comment on concussions. But my father was/is a radiologist - so he'd seen plenty of X-rays of developing bones and knew how tackle football and baseball pitching impacted pre-teen bone, ligament, and tendon development.
Needless to say, neither my brother nor I was allowed to play tackle football or pitch until the age of 12.
Yeah, I'm led to believe that ACL tears would be less prominent if kids didn't start playing sports at like age 4.
My $0.02:
While I agree that more information is good, I disagree with the question posed "when should children be allowed to play tackle football." IMHO this is inherently biased.
What about a more scientific study, like this: Helmetless tackling drills reduce head injuries
Also, I disagree with the CDC spending taxpayer dollars on this. (Trying NOT to inject politics...Nuff said.)
IMHO, the biggest issue at the youth football level is poor coaching. Many kids receive minimal/no instruction on proper technique. I would start first with a mandatory training session with coaches/assistants and officials pre-season to educate proper form. Then, I would pass/enforce stiff penalties for dangerous hits from the early ages up.
But, I would not keep kids from playing.
To me, it is analogous to saying 'kids aren't allowed to swim until they are teenagers due to drowning risk.'
If that were the case, one could argue there would be more drownings due to less skillfull older swimmers. But we don't do that; rather we have developed safeguards such as swimming classes and lifeguards, etc to reduce the risk.
Football safety is evolving, and necessarily so, but what about teaching the game correctly to youngsters instead of just stopping them from playing?
One could argue that we should also disallow young girls from playing soccer, basketball and bicycling due to concussion risk. (Youth concussions facts)
I agree that better safety is important, but it starts IMHO with better educated/trained coaches, officials and parents.
I agree on the importance of education, training, and quality control with the adults involved 100% and first hand that any sport where your head can meet a hard or fast moving object you need to be very aware of safety..
Beyond just competing I actually coached sailing for 4 summers at a competitive yacht club. And one of the corner stones was that if you wanted to be allowed to run class, teach the youngest age group(7 years old) or any of the racing classes, you needed to go take a 24 hour long Level 1 Instructor Certification from US SAILING. Included the obvious stuff like making sure your seamanship was up to snuff, you could tie the knots and all.
But a ton of it was just how to coach safety first, recognizing when a kid might be hurt but not show it, making sure the kids had their boats set up the right way so that lines didnt get tangled and that their PFD's worked, and the like.
In the high schools many of the JV crews are actually now being required to wear a helmet just because they are new to the water often and while I dont find it necessary at my age/level, just starting out it could have been useful and wouldnt have been too mad if the coach required it.
Not trying to be argumentative here, but there's nothing anywhere about taxpayer dollars being used to fund this research. The article explicitly states that they've put out a RFP to experts in the field. Where the funding comes from is not stated, but it's possible it can come from grants, donors, or organizations with a vested interest in the outcome of this research. Yes, taxpayer dollars are a possibility, but I wouldn't consider them to be the likely source of funding for this specific research.
It's federal money. The FOA notice was put out via Grants.gov, which is the unified portal for federal funding opportunities (NIH, etc).
http://www.cdc.gov/injury/fundedprograms/foa/
If this is the correct FOA notice (RFA-CE-15-005), then they expect to award one proposal for about $1.6M, which is a pretty standard grant amount, going by NIH R01 as a baseline.
I suppose I stand corrected then.
Legs all around.
Y'all are the best for turning a sports fan board into a place for informative respectful discourse.
(and uva sux.)
Shoog, First off, thanks for the meaningful dialog so far. My question to you revolves around the following facts. There is certainly a disease of the brain that we know very little about: Chronic Traumatic Encephalopathy (CTE). The link between football and the development of this disease is very strong (see Boston University's work). Currently, CTE can only be diagnosed posthumously, but many of the people who are diagnosed happened to have very troubling symptoms during their life, and many played football. There have been cases of high school football players who have been diagnosed with CTE posthumously, so we know that it can start developing early.
Therefore, if there is a disease that is affecting people, and we know very little about it, why shouldn't the Center for Disease Control fund research about it?
Again, don't read my comments as aggressive :), just trying to speak for the community of folks trying to help public health and really interested to read a response.
Biomech....great comments and I don't disagree that the CDC should research public health risks.
My comment was poorly stated, but let me try again.
To summarize my position, as concussions are a danger in ALL sports, then maybe the CDC should consider a study inclusive of ALL sports and not just football.
Taekwondo, boxing, rugby, hockey concussion risk exceeds football risk; risk for girls is much higher in similar sports than boys, and girls take longer to recover on average.
So why single out youth football?
Let me play with some numbers: The total number of high school football players in the US is about 1,000,000 or about 0.3% of our population. The incidence of concussions in football players is 0.53/1000, or 530. Let's round to 1000 concussions, so we are talking about the CDC funding a study focused on 0.0003% of our population!
The current political landscape seems anti-football to me and I am suspicious that, despite the conclusions noted above this study is powered towards that agenda; and not towards a more global risk assessment that would better serve all sports participants, both girl and boy.
There is a sub-section of the CDC named the Program Performance and Evaluation Office (PPEO) that is charged with assessing efficacy of certain programs and measures in improving health risks.
I would think (my opinion) that this division would be employed in determining which changes have best improved injury outcomes and avoidance. Ex. The NCAA and High School association outlawed spearing in 1976 and achieved a > 50% reduction in C-spine injuries.
CTE is very fascinating, but likely a different beast from simple concussions. We are certainly learning more with better neuro-imaging and there is much to learn, I agree.
But I leave this quote here:
Article here: 2015 Review of CTE in contact sports
I think more research is needed, but I don't feel that the CDC is the vehicle as (my opinion) there are more pressing public health threats for which tax dollars would support. (Touchy subject as I just paid my taxes.....)
Also, a great BMJ 2016 review of Brain injuries in youth sports here: Incidence of concussion in youth sports, BMJ
PS. Also a WFU grad.
Shoog,
This is certainly a divisive topic among both the research community and the general public. There are a few researchers who have publicly voiced their disapproval of the research so far. However, I think there are a larger number that are legitimately concerned about the link between CTE and football. I want to respond to a few different points that you make without trying to discredit them, because I think they are valid. Here goes:
1) As a medical professional, you know that CTE is a pathological disease state of the brain, and can not be diagnosed based on symptoms, nor can we definitively link the symptoms experienced by these retired athletes to this disease. This is a big unknown, but I think the general public is misinformed.
2) While you correctly report there are 1 million high school football players, there are 3.5 million kids playing youth football (i.e. Pop Warner, etc.). That figure says there are roughly 2,200 adolescents playing football for every 1 NFL player. If there is a causation effect of repetitive head trauma and the development of CTE, then it is in my opinion important to know how to protect our youth from it while still providing the vehicle for personal growth and development achieved by the comradery of the sport of football. The causative link between the two is still far off / might not exist, but a lot of evidence points that way and I think it's important to move forward in case that link does exist.
3) The quote you use and the first article that you cite which provides dissent to the research being done in the field was authored by the team neurosurgeon for the Pittsburgh Steelers. I am not questioning his integrity, but if ever there was a conflict of interest that should have been reported, it was there. However, he chose not to say that in the manuscript, and that is concerning.
4) Dr. McKee at Boston University has received close to 100 brains at this point. Of the brains that BU has seen, 70% were determined to have CTE. Of football alone, 80% had CTE, and of NFL players alone, 96% had CTE. That is a staggering percentage.
5) However, we are still awaiting matched-pairs data. If we had a handful of retired athletes that were exposed to head impacts throughout their careers that also had siblings that did not, then that would be the jackpot. We could tell if this tauopathy was a genetic disease or a function of the head impacts.
6) Finally, in my personal opinion, the focus on concussions as the cause of CTE is misplaced by the public. As a biomechanical engineer, I think the cause of CTE is the development of strain at the depths of the sulci during head impacts, even in the absence of clinically diagnosed concussion. The fact that this disease has been seen in football players is most likely a function of not only the number of concussions, but also the number of sub-concussive blows they received throughout their career. Using highly detailed models of the brain, we are seeing mechanical stretching of the material in the same location as the Tau protein deposition in CTE in low impact scenarios and also in high impact scenarios (http://www.ncbi.nlm.nih.gov/pubmed/26762217).
P.S., I originally didn't mean for this post to be so long. However, I thought that it contains important information that some people would find interesting. I've tried to steer clear of politics and opinions (except for pt. 6). You are entitled to your opinion that the CDC shouldn't be funding youth football research. I disagree, but that is ok. Thanks for the dialog, Shoog!
"That is a staggering percentage."
I'll say...
Do we really have to wait around for sibling brains?
I always thought the reward was worth the risk. I'm having serious doubts, right now. Sad, serious doubts.
coach mcguirk,
Take those percentages with a grain of salt. There is a reason that those brains were sent to BU. It is heavily skewed toward the people who were very symptomatic in life. However, those data are real. A lot of people are curious what the true incidence is and what percentage of the people who have this pathology are symptomatic. These two questions are important to get answers for.
I'm glad that my comments have been informative :)
Thanks for that comment as well.
I was hoping that was the case and that helps. A little.
You beat me to it. It's important to realize that the only thing we know now is that those with symptoms have CTE. We don't know that all people with CTE have symptoms. We don't know the cause of CTE. We don't know how many people living an absolutely normal life could have CTE. For all we know, some type of drug or supplement could be the cause. Because of all these unknowns, I agree with having taxpayer money go to research and I hope we learn more soon.
Thanks for the reply.
This is great information and I will read it in more detail later with more time.
I am intrigued with the mechanisms that you mention and possible associated genetic predispositions.
I agree that further research and dissemination of this type of information is the answer to reducing damage, preventing injuries.
EDIT: I was able to read the Biomechanics abstract that you linked. (Is this your work? How cool that VT and WFU partnered for biomechanical engineering-sounds like you are in the trenches.)
I'm encouraged by advances in neuroimaging b/c as 'good' as MRI's are, I am limited diagnostically as you mentioned in practice. Dementias, demyelinating processes, concussions and as you mentioned CTE and other processes escape us without definitive imaging. Neurofunctional scans are not available to us in practice, but I suspect this will eventually help with the above and many other disorders such as psych and addictions.
I don't mean to come off as doubting any connection between trauma and later pathologies. I agree that the likely association is powerful and demands further research.
And maybe I'm being too naive in hoping that the appropriate entities would fund unbiased research. The Sports and Health Research Program was funded in part by the NFL starting in 2012 with $30 million which is a great start and I would prefer these types of initiatives versus taxpayer funded CDC programs. (Just like I dislike taxpayers footing the bill for NFL stadiums, but again, my naivete...) You correctly identify the potential conflict in the article I cited.
It sounds like you are doing very impressive and important work and I'm hoping that this new attention will help keep the kids and future athletes safe.
The key is to teach these kids, as young as possible, that you should launch with your head down in the general direction of the ballcarrier's head/neck area.
I still have bad feelings for Zumwalt and the announcers and UCLA, and that bowl game....
Yes, I need some therapy.
The problem isn't necessarily with coaching at youth levels. I have coached football at all levels up to high school and have to say that the tackling form on younger players is better. They might watch the football of higher levels but they haven't developed the idea of just needing a big hit to impress people. High School players more and more are developing that attitude to impress their coaches and friends, as well as to get more notice from college coaches.
"They might watch the football of higher levels but they haven't developed the idea of just needing a big hit to impress people."
You didn't mention the age, but I can say from my personal experience many years ago, as well as closely observing youth football fairly recently, that by the time some kids hit the age of eleven, they want to rock somebody. There are VAST differences in how rough kids are that is highly correlated to their socio-economic status, upbringing, etc. Kids from tough neighborhoods are going to bring it at an early age.
I have been following this thread with great interest. I played football in the 70's, starting at age 12, and tackled guys leading with my helmet all the time. I was 5'10 150/lbs according to my first drivers license, but I figured out I got the most bang for my buck (PSI) hitting that way. I have no idea how I didn't break my neck, and I am certainly paying for it now in my old age. So I certainly agree with the notion that coaching correct tackling form is uber important, and coaches should know what they are doing at all levels. I can say that things are certainly much improved, but could still stand much improvement. It just seems the reality of what is necessary is an impossible task.
I also believe - call me a Neanderthal - that football makes men out of boys. And I didn't hesitate to put my son into the sport, push him when he needed it, support him, coach him, and be there with him the whole way. It's a scary thing for most young kids to step out there and try it, and I always told kids as a coach, that whether it worked out or not, just putting themselves out there proved they were cut from good cloth, and they should be proud of themselves. My son was pretty dang good by the time he played in HS, and was a 3 year starter. He's in his mid 20's now, and I am certain that the toughness he gained from the sport is helping him now.
It is definitely a dangerous game, and I wonder if we are seeing the beginning of the end. But it also offers such camaraderie, a sense of accomplishment, and teamwork/team spirit that cannot be matched (IMO) in other sports. I don't know if it is an American thing, a manly thing, or what, but the love for this game is unmatched. As a player, It is almost a trial by fire, and the pride you take in being a "football player" is something (Al Bundy jokes commence...3,2,1...now) that you keep your whole life.
As I understand it, the danger that's difficult to quantify is the repeated hits. I have no doubt that correct tackling technique can limit the number of 'dangerous' hits, but the repeated hits still take a toll - especially in a growing/underdeveloped body/brain.
Above, Shoog said:
I think the correct question is "How many 'average' hits in a time period of X days can cause permanent damage to child's brain (where child = Y years of age)?" If 50 'average' hits over 90 days will cause permanent damage to a 7 year old, then I would argue that 7 years old is too young to play tackle football. If it's 700 'average' hits over 90 days will cause permanent damage to a 7 year's brain, then maybe it's okay to start playing football at 7 years old.