America's Complicated Relationship with Football

Super Bowl 50 this Sunday is expected to be the most watched, most Tweeted-about and most bet-upon event in U.S. television history.

By so many indications, football’s stranglehold on American culture is as tight as it has ever been.

Yet, an increased awareness of football-related brain damage and the recent headline-grabbing Hollywood flick Concussion starring Will Smith is causing many parents to take a second-look at their love affair with America’s most popular game – especially when it comes to their children.

“It is a concern: How young do you allow a child to start playing competitive sports that are at high risk for developing a concussion?” asked Jamie Ullman, MD, director of neurotrama at Northwell Health’s North Shore University Hospital. “Certainly, the younger the brain, the more at risk it is for damage.

“The brain is still developing and neuronal connections are still developing. And when you consider the musculature of young children [under 12], they are not well-developed enough to withstand bodily injuries,” she added.

Many parents are taking notice of the avalanche of information in the media about the serious effects concussions have had on the professional level. The number of children participating in youth and high school tackle football has dropped dramatically in recent years – an 18 percent decline between 2009 and 2014, according to data from the Sports and Fitness Industry Association.

“Children are more vulnerable to the effects of concussions and [other] head injuries. Concussions may last longer in younger children, and we need to able to recognize when a concussion occurs and when a child should not be playing,” Dr. Ullman said. “In order to decide whether to go into football all together, understanding those risks is important.”

Concussion highlights some of those risks in dramatic fashion. The movie tells the story of Dr. Bennet Omalu, a forensic neuropathologist who was among the first researchers to bring to light a connection between football and severe brain damage caused by repetitive head injuries. The film details the NFL’s efforts to quiet Dr. Omalu and serves as an indictment of the league’s handling of brain injuries suffered by its players.

Dr. Omalu, portrayed by Smith, coined the term chronic traumatic encephalopathy (CTE) to describe the brain disease he discovered in deceased NFL players. Ninety of 94 former NFL players who donated their brains to science after death -- including Hall of Famers Junior Seau and Mike Webster and former New York Giant Tyler Sash -- have tested positive for CTE, according to the U.S. Department of Veterans Affairs and Boston University.

Just this week, it was revealed that Oakland Raiders great Ken Stabler had “moderately severe” CTE at the time of his death last year.

For parents and their children, the important takeaway from Concussion and all the media coverage is awareness, said Robert Duarte, MD, director of the Pain Center at Northwell’s Cushing Neuroscience Institute.

“The film raises awareness that concussion is a brain injury and that it could lead potentially, years down the line, to cognitive dysfunction in the athlete,” Dr. Duarte said. “It at least allows parents and players to have that knowledge, to prevent the concussion, if you can, by proper tackling, by not using your head as a weapon.”

Dr. Ullman said the movie illustrates the need in football, as well as other contact sports, for improvement in concussion recognition.

“Any film that brings to light the problem of concussions in sports is one that’s doing a service,” she said. “We really do need to be aware of this … We need to know what to do to treat a concussion and when it’s appropriate to return to play after a concussion.”

Dr. Ullman said it remains unclear whether CTE “will be showing in everybody who plays football. “It’s probably premature to assume that any given player with repetitive sub-concussive hits, in addition to concussive injuries, is going to go on to have the same long-term effects that have been shown in some of the famous cases,” she said.

Drs. Duarte and Ullman both noted that the “Heads Up Football” coaching campaign funded by the NFL and spearheaded by youth football’s governing body USA Football is geared toward teaching children proper and safer techniques in tackling and blocking.

The program’s goal is to encourage players to keep their heads up and avoid using the top of their helmets as weapons during on-field collisions. Critics of “Heads Up” call it a marketing ploy and say it’s a reincarnation of terminology that’s long been a part of coaching the game.

When you consider the whirlwind of high-speed violence that occurs on every football play, the tackling techniques are “laughable,” Nate Jackson, who played six seasons as a tight end for the Denver Broncos, said in an ESPN report.

One of the more poignant scenes in Concussion quotes a Pittsburgh Steelers neurosurgeon telling Dr. Omalu in 2007: “If just 10 percent of mothers decide that football is too dangerous for their sons to play, that is it, it is the end of football. Kids, colleges and eventually, it’s just a matter of time, the professional game.