Will Brain Injuries End the Game of Football?

The Consequences of Playing Football 

I grew up in Nebraska where participation in sports was at the core of a young person’s social, educational, and physical development. It was how we learned important lessons about winning, losing, and being part of a team. Football was a big part of our culture, but it was even more. Our identity was intertwined with the successes, or struggles, of our team. I still enjoy watching football games just as millions of Americans do. But recent reports about its health effect on most of the players gives me pause.

The medical journal, JAMA, recently published a study that found 99% — 110 out of 111 — of deceased National Football League (NFL) players whose brains had been donated to science suffered from chronic traumatic encephalopathy (CTE). Among deceased players across all levels of American football (including high school, college, and professional) whose brains were studied, 87% — 177 out of 202 — were diagnosed with CTE. This is a neurodegenerative brain disease caused by repeated head trauma, including concussions.

What Repeated Head Trauma May Cause

This is an alarming report, but we need to understand that the study may have been biased. First of all, there was no control group. Second of all, the families of football players who had CTE symptoms may have been more likely to donate the brains of their loved ones, so this was not a random sample of NFL players and cannot be generalized to all NFL players. It is unclear how many NFL players actually develop CTE. But certainly, many do. This, by itself, should obligate the NFL to initiate efforts to mitigate the harm.

According to the New York Times, symptoms can arise “years after the blows to the head have stopped.” That means your teenagers or young adult children who play high school or college football may seem fine to you now. But the consequences of the repeated head trauma they experience might eventually cost them their happiness, health and, perhaps, their lives.

In an attempt to prevent the short-term and cumulative effects of brain trauma from sports, the University of Pittsburg Medical Center-Center for Sports Medicine developed an on-line computer-based neurocognitive test to manage concussions. It is intended to be used at baseline before a player begins a season. In the event there is a concussion, the player can be tested in real-time and, if there’s an abnormality, testing can continue periodically until the results return to baseline. This is currently being used in 75% of Nebraska high schools and is not limited to football players.

AMA Resolves to Ban Boxing

In December of 1984, “The American Medical Association [AMA] adopted a resolution…calling for the abolition of boxing, both amateur and professional, and urging medical groups throughout the country to lobby for state laws banning the sport because of ‘the dangerous effects of boxing on the health of participants,’ ” according to the New York Times. Dr. Joseph R. Boyle, who was the president of the AMA at the time, said, ”I believe the physicians all over the country should participate in a public dialogue which would ultimately lead to persuading legislators and the public that this is indeed a very dangerous sport and that it ought to be outlawed.”

The AMA’s resolution faded into the background over the years. Then a 25-year-old Scottish boxer named Mike Towell was killed during a boxing match in 2016, and there were renewed calls to ban boxing. Towell’s death prompted Peter McCabe, the chief executive of Headway, a brain injury charity, to make this statement: “…how many more lives have to be damaged or lost before this senseless sport is banned? As long as boxing is allowed to continue, more and more young lives will be damaged or lost as a result of opponents deliberately trying to cause neurological harm to each other.”

The Telegraph printed an opposing opinion. “…those arguing that boxing should be banned because it is too risky need to take a risk-reality check. Risk is a fundamental part of life. Where we don’t have sufficient risk, we create our own – through sport, competition, or less constructively in gangs, crime and even radical extremism. Disliking this doesn’t make it any less a fact.”

Do as the Romans?

There are strong opinions on both sides of the issue. But we should ask if we want our talented athletes, particularly our children, treated in the same way as ancient Romans used their gladiators–for entertainment, even though it would inevitably end in injury or death.

As a self-confessed sports enthusiast, I don’t want to be an evangelist for banning boxing, football, or any other sport. I enjoy watching the performance of great athletes, and being wrapped up in the excitement of cheering on my favorites. I value the incredible skills that athletes demonstrate, and I understand the emotional investment their fans make.

Time for Physicians to Step in and Demand Change

But if we know the current rules of a game such as football can lead to a horrible disease, maybe it’s time for physicians to step in and demand change. Perhaps the level of risk associated with football can be lessened, or eliminated, with monitoring of cognitive function. If there is a change in cognitive functioning following a blow to the head, players should be prevented from participating until the cognitive test results return to normal. Maybe, if we implement that safeguard, then one day, we can watch our team win the Super Bowl without wondering which of them will join those whose lives who are destroyed by CTE.

Photo by Ben White on Unsplash


  1. holly webster on July 29, 2017 at 12:02 pm

    Concussions have historically been thought of as mild “dings” but the newest evidence argues against that. There are serious effects from a single hit, and cumulative concussions result in exponential long term brain injury. CT scans do not reveal any structural injury in concussions, so do not feel reassured by a normal scan. The damage is microscopic and metabolic, processes that are not demonstrated by a CT. But the evidence is in neuro-cognitive testing.
    I think that it is unlikely that many parents will refuse to allow their children to participate in sports – so the other consideration to add to this piece is that parents of children playing football, soccer and Lacrosse [in particular] should receive pre-season information about potential harm to their child – basically, an “informed consent” document that is used in the medical field before surgery/procedures. And with this information, recommendation is also made to the parents about having a low threshold for follow-up evaluation of a child who has had an impact event. Parents need to realize, for football, that helmets do NOT protect from concussions, and for other non-helmet contact sports, the risks are significant as well.

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