Is football safe to play? The short answer is that football is no more dangerous than many other common sports that kids play.
As parents, we all want our kids to have a fun and safe childhood. We know football is fun, but in recent years its safety has been called into question. Most parents don't have hours or days to devote to finding and reading medical research on football safety. For many, it's easier to say no to football. In an effort to ensure we're providing the safest athletic experience possible for all the children in our charge, including our own, we decided to review publicly available research on football safety. We're parents too, so we needed to convince ourselves that football was still a safe sport for kids to play. Having satisfied our own concerns, we've consolidated the relevant findings to share with you.
Our past and current efforts focus primarily on evidence based scientific studies published in well known journals. All the research we reviewed is publicly available and can be read in its entirety if you wish. We encourage you to reach out to us for more information if this summary doesn't set your mind at ease.
Sports safety is a concern for all parents, particularly in contact sports like football. We love the game of football and believe very strongly that it can play a major role in developing kids into resilient young men and women of good character. It can provide skills and experience that will help them to better overcome adversity in life, to embrace challenges, and to help them succeed at whatever they put their mind to. They learn to work hard, both individually and as a team, toward a common goal. They learn leadership skills. They learn how to overcome hard fought losses with grace and how to enjoy hard fought wins with humility. These critical life lessons are only a few of many reasons why we encourage kids to play this fantastic sport, and why we encourage our own kids to play. While no athletic activity is 100% risk free, most parents are willing to accept some reasonable level of injury risk to allow children to benefit from the sports/activities they love.
Why then has the risk seemed to outweigh the reward these past few years? Several years ago, a Boston University study created a great deal of fear owing to how the media portrayed that study. The study was not representative of the entire football community and the authors openly acknowledge that there are major limitations with their study, including selection bias. The authors further state that "caution must be used in interpreting the high frequency of CTE in this sample, and estimates of prevalence cannot be concluded or implied from this sample". Then the authors encouraged further research, which has been ongoing. The BU study wasn't designed to examine the entire football community but the media and parents at large are drawing that correlation. The media, by failing to understand and explain the BU study limitations, created a narrative which would have parents believe that football causes CTE and all players at all levels will be harmed. Once that message was out in the mainstream it took on a life of its own. Parents pulled back from football participation without the benefit of accurate information to make an informed choice.
Many studies have followed in the years since. Unfortunately, these studies are not the eye popping headline type and thus get very little play in the media. As such, it has been challenging to move public perception past that BU study. The medical community has been expanding it's research in an attempt to address the substantial limitations and selection bias of that BU study, as well as to advance knowledge of sports injury though evidence based inquiry. Research is often slow, owing to the methodical nature required to do the job properly. Years are required to structure, fund, and complete a study. The past five years have provided sufficient time to complete a fair number of significant studies which we are grateful for. We hope these studies help make all sports safer for our kids and also provide parents with accurate information for sports selection. We believe football is safe relative to other commonly played sports such as soccer, basketball, hockey, lacrosse, and others. We also believe it is an important element in keeping our kids physically active and is a useful tool for developing kids into responsible and resilient young adults. It's also just plain fun. Kids love the sport, and kids will engage in the things they love the most. In addition to the scientific data provided below, we encourage you to come talk to our coaches, players, and parents during any one of our practices or games and learn for yourself how football can have a positive influence on your child and why we believe the sport of football is safe for kids to play.
June 2019 - Kevin F. Bieniek, Department of Neuroscience, Mayo Clinic (REF#1)
"Association between contact sports participation and chronic traumatic encephalopathy: a retrospective cohort study"
published on June 14, 2019 in Brain Pathology ISSN 1015-6305
- "playing youth and high school football did not strongly correlate with CTE later in life" (page 6)
- "most players of youth or high school football do not experience CTE outcomes" (page 8)
- "associations between football and CTE are strongest for participation beyond high school" (page 10)
May 2019 - Cynthia LaBella, MD. Medical Director, Institute of Sports Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago, Professor of Pediatrics at Northwestern University’s Feinberg School of Medicine.
Chairperson of the American Academy of Pediatrics Council on Sports Medicine and Fitness.
"Youth Tackle Football: Perceptions and Reality"
published in Pediatrics Volume 143, No. 5, May 2019
- "The most notable finding of this study, however, is that most parents perceive concussion rates in tackle football to be substantially higher than they actually are."
- "The reality is that the concussion rate in youth tackle football is lower than parents perceive" ... "and is similar to concussion rates in other youth contact sports, such as soccer, ice hockey, lacrosse, and even flag football."
November 9, 2018 - Dr. Munro Cullum, UTSouthwestern Medical Center (REF#2)
"The Concussion Myth"
published in UTSouthwestern Medical Center Medical Blog, November 2018
Upon hearing concerned parents say that they'd never let their kids play certain sports, Dr. Cullum points out that, according to the Centers for Disease Control and Prevention, the No. 1 concussion risk for people under the age of 20 is falling off a bicycle. He asks those parents if they ever plan to let their kids ride bikes.
October 2018 - Barry S. Willer, PhD., University of Buffalo (REF#3)
"A Preliminary Study of Early-Onset Dementia of Former Professional Football and Hockey Players"
published October 2018 in The Journal of Head Trauma Rehabilitation
- None of the retired contact sport athletes qualified as having early-onset dementia consistent with chronic traumatic encephalopathy.
- No significant differences were found when comparing contact-sport athletes with controls on the presence of mild cognitive impairment or brain structural and functional tissue injury.
- Twenty-two retired NHL and NFL athletes (average age 56 years) and 21 age-matched noncontact sport athlete controls were recruited for this study.
- There were no remarkable differences in imaging, cognition, behavior, or executive function from noncontact sport athletes.
- The results underscore an apparent disconnect between public perceptions and evidence-based conclusions about the inevitability of chronic traumatic encephalopathy and the potential neurodegenerative effect on former athletes from contact sports.
March 2018 - Cynthia LaBella, MD. Medical Director, Institute of Sports Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago, Professor of Pediatrics at Northwestern University’s Feinberg School of Medicine. Chairperson of the American Academy of Pediatrics Council on Sports Medicine and Fitness.
Written Testimony Sent March 1, 2018 to the Illinois House of Representatives "Written Testimony of Dr. Cynthia LaBella to the lllinois House of Representatives"
there is no data to show that eliminating tackling in youth football will reduce the risk of neuropsychiatric symptoms or disorders in adolescence and adulthood and/or prevent CTE.
it is important to note recent data showing that injury rates in youth flag football are the same as injury rates in youth tackle football based on recent studies.
There is no study to date showing the effect of delaying the age at which tackling is introduced to football on risk of injury. Delaying the age at which tackling is introduced to the game may decrease injury risk for the age levels at which tackling would be prohibited. However, once tackling is introduced, athletes who have no previous experience with tackling would be exposed to collisions for the first time at an age at which speeds are faster, collision forces are greater, and injury risk is higher. Lack of experience with tackling and being tackled may lead to a substantial increase in the number and severity of injuries once tackling is introduced.
it is important for the committee to know that for the overwhelming majority of children and adolescents, the benefits of organized sports (e.g. lower rates of diabetes, heart disease, and depression), far outweigh the risks, even for tackle football.
2017 - Andrew R. Peterson, MD, MSPH (REF#4)
"Youth Football Injuries: A Prospective Cohort"
published in The Orthopaedic Journal of Sports Medicine, 2017
Hypothesis Tested: Does Youth flag football have a lower injury rate than youth tackle football? Are the concussion rates in flag football lower than in tackle football?
Study Conclusion: Injury is more likely to occur in youth flag football than in youth tackle football. Severe injuries and concussions were not significantly different between leagues. Concussion was more likely to occur during games than during practice." ... "Rates of injury in youth football are relatively low. Youth flag football has a higher injury rate than tackle football. A significantly different rate of severe injury or concussion between tackle and flag football was not identified" ... "Furthermore, we cannot conclude that youth flag football is a safer alternative to youth tackle football."
May 2015 - Thomas P. Dompier, PhD, ATC (REF#5)
"Incidence of Concussion During Practice and Games in Youth, High School, and Collegiate American Football Players"
JAMA Pediatr. 2015;169(7):659-665. doi:10.1001/jamapediatrics.2015.0210Published online May 4, 2015.
Concussion incidence rate for a youth football game is 2.38 per 1000 Games (Range of 1.85-2.92 yields a 95% Confidence Interval) or 1 incident in 342-541 games for a single individual
Concussion incidence rate for youth football practice is 0.59 per 1000 Practices (Range of 0.44-0.73 yields a 95% Confidence Interval) or 1 incident in 1,370-2,272 practices for a single individual
Concussion incidence rate for a High School football game is 2.01 per 1000 Games (Range of 1.79-2.22 yields a 95% Confidence Interval) or 1 incident in 450-559 games for a single individual
Concussion incidence rate for High School football practice is 0.66 per 1000 Practices (Range of 0.60-0.72 yields a 95% Confidence Interval) or 1 incident in 1,389-1,667 practices for a single individual
Hopewell Valley Youth Football has approximately 31 practices and 8 games per regular season. Fewer than 31 practices allow for full contact drills. Of those, only small fraction of the two hour practice time involve full contact. On an individual basis, the risk of concussion is low.
REFERENCES:
#1 - "Association between contact sports participation and chronic traumatic encephalopathy: a retrospective cohort study"
published on June 14, 2019 in Brain Pathology ISSN 1015-6305
Kevin F. Bieniek, Department of Neuroscience, Mayo Clinic, Jacksonville, FL
Melissa M. Blessing, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
Michael G. Heckman, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
Nancy N. Diehl, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
Amanda M. Serie, Department of Neuroscience, Mayo Clinic, Jacksonville, FL
Michael A. Paolini, II, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
Bradley F. Boeve, Department of Neurology, Mayo Clinic, Rochester, MN
Rodolfo Savica, Department of Neurology, Mayo Clinic, Rochester, MN, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
R. Ross Reichard, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
Dennis W. Dickson, Department of Neuroscience, Mayo Clinic, Jacksonville, FL
#2 - "The Concussion Myth"
published in UTSouthwestern Medical Center Medical Blog, November 2018
C. Munro Cullum, PhD (written by Michael J. Mooney)
#3 - "A Preliminary Study of Early-Onset Dementia of Former Professional Football and Hockey Players"
published October 2018 in The Journal of Head Trauma Rehabilitation
Barry S. Willer, PhD
Robert Zivadinov, MD, PhD
Mohammad N. Haider, MD
Jeffrey C. Miecznikowski, PhD
John J. Leddy, MD
#4 - "Youth Football Injuries: A Prospective Cohort"
published in The Orthopaedic Journal of Sports Medicine, 2017
Andrew R. Peterson, MD, MSPH
Adam J. Kruse,MS
Scott M. Meester, BS
Tyler S. Olson, BS
Benjamin N. Riedle, MS
Tyler G. Slayman, MD
Todd J. Domeyer, MD
Joseph E. Cavanaugh, PhD
M. Kyle Smoot, MD
#5 - "Incidence of Concussion During Practice and Games in Youth,High School, and Collegiate American Football Players"
JAMA Pediatr. 2015;169(7):659-665. doi:10.1001/jamapediatrics.2015.0210Published online May 4, 2015.
Thomas P. Dompier, PhD, ATC; Zachary Y. Kerr, PhD, MPH; Stephen W. Marshall, PhD; Brian Hainline, MD;Erin M. Snook, PhD; Ross Hayden, MA; Janet E. Simon, PhD, ATC