Unique study explores cumulative effect of
hits in high school football
Sports Illustrated
Wednesday, April 13, 2011 12:17PM
David Epstein
Last November I wrote an article for Sports
Illustrated about a unique study on brain
injuries in high school football players
conducted by a group of researchers at Purdue
University.
The reason I honed in on this particular study
was that, rather than dissecting the brains of
deceased players to look for signs of chronic
traumatic encephalopathy (CTE), this group was
following young players over the course of a
season to see if they could document brain
impairment in real time. In other words, as
opposed to a "cross-sectional" study -- in which
observations are made at a single point in time,
but the cause/effect relationship cannot be
definitively established -- this study was
longitudinal, meaning that it would track players
over the course of the season.
The researchers put accelerometers in the
helmets of players at Jefferson High School in
Lafayette, Ind. with the intention of measuring
the G-forces of hits that caused concussions.
The idea was then to give the players tests of
memory and focus as well as to take pictures of
their brain activity using functional magnetic
resonance imaging (fMRI) to see just how a
concussion altered cognitive processing.
But when the researchers started dragging in
apparently healthy non-concussed players for
memory tests and fMRI's to establish a control
group, they were surprised to discover that
several players had impaired brain functioning
despite not having suffered a concussion.
Ultimately, the study found that the sheer
number of hits that a player had taken over the
previous week, completely irrespective of
whether a concussion had been suffered, was the
best predictor of brain impairment.
As I wrote last November, this is particularly
scary, because it means that the vast majority of
brain damage in football players might be
occurring in the absence of any easily
recognizable symptoms or of a particularly bellclanging hit.
The Purdue researchers recently finished
analyzing the second year of their Jefferson
High data -- which was discussed as part of
Frontline's "Football High" special on PBS -and it has shown more of the same. Of the 31
times that the researchers brought in nonconcussed players to do neurocognitive testing,
17 produced impaired scores. "That's 17 players
who were not expected to be impaired," said
Tom Talavage, a Purdue associate professor of
biomedical engineering and electrical and
computer engineering.
The fMRI data has backed up the results from
the first season as well, in that the pattern of
brain activity in impaired players changes when
they are asked to do a task that requires mental
focus. In tests where players are asked to briefly
recall letters that have been flashed before them,
the impaired players appear to require more
cognitive resources to complete the relatively
simple task. It's as if the brain is a damaged
engine that suddenly needs to use more
horsepower than should be necessary just to get
the vehicle down the block. "They can still do
the test," Talavage said, "but not in the same
manner as when they were healthy."
On the bright side, so far kids in the study have
returned to normal brain functioning after the
season. The Purdue researchers hope they can
one day pin down just how many hits it takes
before someone is set irreparably on the path to
CTE. Since the number of hits taken in the prior
week has proven in both seasons of the study to
be the best predictor of brain impairment,
Talavage envisions one possible solution:
monitoring hits as one would monitor a pitcher's
pitch count. "If we can just slow down the
accumulated damage so that we don't pass
whatever threshold leads to CTE," Talavage
said, "then that's a win. That's the same for most
people as eliminating the problem."
Now that we pretty much know what to expect
when the brain of a deceased ex-NFL player is
examined -- a buildup of tau proteins that are
the hallmark of CTE -- longitudinal studies like
the one at Purdue hold the key to figuring out
how to make the game safer.
Listening to Wisdom From a 10-Year-Old
Son About His Head Injury
ADAM BUCKLEY COHEN
New York Times
November 28, 2009
“Dad, I’m scared. I only have one brain, and I
don’t want to hurt it playing football.”
My son Will, his 10-year-old eyes filling with
tears, was trying to decide whether to play
quarterback in his peewee game against
Roosevelt Elementary. Ten days earlier, he’d
taken a helmet-to-helmet hit during practice and
possibly, although we really don’t know,
sustained a concussion. Now I wanted to help
him make the right choice — if only I knew
what that was.
For several years, I have been following the
furor over football and head injuries. I’ve
become all too familiar with accounts of N.F.L.
veterans exhibiting Alzheimer’s-like symptoms
in their 40s, of teenagers dying after playing too
soon after a concussion. But these tragedies
didn’t seem very relevant to my own life until
Will took that first big hit.
I wasn’t there, but he told me afterward that he
went to the sideline to lie down. He thinks one
of the coaches checked on him, but he can’t
remember. Because he fell asleep.
He fell asleep? Isn’t that the first thing they tell
you to avoid in a head-injury situation? Was this
the moment I’d been dreading since his mother
(grudgingly) and I (excitedly) told him that, yes,
he could play tackle football?
Was this a concussion?
Will spoke clearly, and his memory seemed
intact. He did his homework with no trouble. In
short, he seemed his usual, fifth-grade self. He
returned to practice the next week, after a
pediatric nurse practitioner assessed him —
looked into his eyes, asked him a few questions
— and cleared him. When she mentioned in
passing the idea of seeing a neurologist, I
shrugged it off.
I don’t know why, at this crucial moment, I
didn’t remember all I’d read. Or why I didn’t
discuss the situation with Will, the person
affected most by my decision. He was fine, I
decided. And everything seemed that way until
the morning of the Roosevelt game, when he
told me he didn’t want to play.
At first, he said only that his stomach hurt. But
as I asked more questions, he brought up the
subject of concussions. Will, it turns out, knew
more than I realized. He’d read Troy Aikman’s
account of being unable to remember a Super
Bowl victory. He knew that Steve Young had
retired because of concussions. And he
recognized that if he kept taking hits year after
year, he could suffer the same fate — or worse.
As he explained his fears, I thought about why I
wanted him to play that afternoon. Like most
parents, I wanted my child to experience
competition and learn the lessons that sports
teach. There was more, though. I was using Will
to live out the gridiron fantasy my mother had
short-circuited when she’d forbidden me to play
as a kid.
But when Will voiced his fears, I woke up. This
was one of those moments that could have
changed the lives of the children I’ve been
reading about, kids who played through pain
and got seriously hurt.
And so Will did not suit up against Roosevelt.
Still, when he soon after informed his mother
and me that he was ready to return to the team,
we allowed him. He took his share of hits over
the final few games, but he’s already announced
that he’d like to play football again next fall. We
haven’t yet decided what we’ll do.
If we choose to let him take the field again,
we’ll do our best to learn from all of the
information that’s come to light. Before the
season begins, we’ll take Will to a neurologist
for baseline testing. If he takes another hit like
the one this season, he’ll go back to the
neurologist, who will do a proper examination
to determine when, or even if, he’s fit to return.
One day, helmets may come equipped with
sensors that measure the impact of each blow a
player takes. Perhaps neurologists will populate
the sidelines in the same numbers as trainers and
those guys who squirt electrolyte-replacement
drinks into players’ mouths. Whatever happens,
we’ll no doubt remember this era as one of
those “before” times, much as we recall
automobiles before seat belts and airbags or
restaurants before smoking bans.
This Sunday afternoon, I am taking Will and his
brother Theo to see our beloved Philadelphia
Eagles. Theo will sport a Donovan McNabb
jersey, and Will will don Brian Westbrook’s 36.
Only Westbrook won’t be playing; he’s out after
sustaining a pair of concussions.
When I told Will that I wished Westbrook
would play, he shook his head.
“He shouldn’t play until he feels 100 percent
better,” Will said. “Because even though
football is all he does, he still needs his brain.”
Once again Will reminded me that no matter
how many articles parents read, we can still
learn plenty by listening to our children.
Adam Buckley Cohen is senior vice president
and general counsel of the Oklahoma Medical
Research Foundation.
New Beginnings
Time for Kids
Vickie An
February 22, 2011
After a serious accident ended his
snowboarding career, Kevin Pearce is starting
over and looking to a new future
Kevin Pearce, 23, has no memory of the crash
that brought his snowboarding career to a
grinding halt. On December 31, 2009, he was
training for the 2010 Winter Olympics in Park
City, Utah, when he fell and hit his head on the
edge of the halfpipe. The athlete had been
practicing one of the sport's most difficult tricks,
a soaring double-cork move.
Luckily, he was wearing a helmet. Doctors say
it saved his life. But he suffered a traumatic
brain injury that affected his vision, balance and
memory. He spent four months recovering in
hospitals in Utah and Colorado. He still can't
recall several weeks of his life after the
accident. "It's definitely strange," Pearce says,
peering through thick, black-framed glasses.
The special lenses keep him from seeing double.
What he does remember is watching the
Olympics on TV from his hospital bed, and
seeing rival snowboarder Shaun White grab the
gold. Friend Scotty Lago took the bronze medal.
"It was hard lying there in the shape I was in,
watching those guys do amazing tricks," admits
Pearce, who was one of the sport's top
competitors before getting hurt.
Moving Forward
Today, Pearce's focus is getting his health back
to 100%. So far, he's made incredible progress
in his physical therapy sessions. A year ago, he
couldn't walk straight. Now, not only can he
walk, he can drive again too.
Pearce says he owes his speedy recovery to the
support of his fans, his friends and mostly, his
family. His parents and older siblings have been
by his side through it all. In May, he moved
back into his family home in Norwich,
Vermont. His brother Adam left his job to help
care for him full time. "All I wanted was to see
Kevin get better," Adam told TFK. "It feels like
I'm in the right place and doing the right thing."
Pearce adds, with a wide grin, "He was my
license."
Pearce also credits his brother David, who has
Down syndrome, for playing a role in the
emotional healing process. "Growing up with
David has taught me a lot of patience," he
explains. "He's taught me how to take life more
slowly." Pearce's mother, Pia, says her youngest
son's positive attitude helped too. "I knew Kevin
was going to find a way to be okay," she told
TFK.
On the Road Again
These days, Pearce is back on the snowboarding
circuit. Instead of performing tricks, though,
he's commenting on them from the broadcasting
booth. In December, he cheered on his fellow
snowboarder friends at the Winter Dew Tour
stop, in Breckenridge, Colorado. He also
attended another Dew Tour event, in Killington,
Vermont, in January. And last month, he gave
his expert analysis on the Winter X Games for
ESPN.
Meanwhile, the athlete in him still craves the
competition. But he understands the
consequences of another fall. When Pearce does
ride again, he says, "I'm going to snowboard
mellow. I'm all right with just getting to cruise."
Is Football Just Too Dangerous?
Larry Strauss
Huffington Post
11/01/2013
I put the pads on when I was 9 years old and
would have played football in high school if I'd
been eligible. I appreciate the game. The
excitement of it. The intensity of the battles. The
drama of a tight 4th quarter. And the way it tests
young men's strength, will, and determination in
their struggle against pain and gravity and
aggression. I appreciate the coaching battles.
The strategic nuances. And I appreciate
football's place in our culture -- the Friday
battles of high school, the Saturday showdowns
in the NCAA, and the Sunday clashes of the
NFL. Wars fought on grass and turf. School
against school. City against city. Wars in which
no one has to die -- except that people are dying
from playing football, a relatively small number
during the game and many not so long after
years of playing, more of them than we used to
realize -- enough to make me relieved that I
wasn't eligible to play for my high school.
A number of recent articles, books, and
television documentaries (including the recent,
PBS Frontline, League of Denial have shined
the spotlight on new research about head trauma
and brain injuries and the toll taken on the lives
of the boys and men who play football. The
tragic stories of Junior Seau, Mike Webster, and
others stand in for lesser known football players
who suffer and often die prematurely in silence.
Not all scientists agree with the research and the
NFL has been slow to acknowledge the extent
of the dangers of its game, but there is enough
evidence for at least parents and educators to be
concerned.
And I cannot help wondering about high school
football. I mean, should there even be high
school football?
Just asking that question is probably an affront
to players and their fans at every level. But I'm
asking because the question needs to be asked.
Because don't we put student safety above all
else?
It's why we take even the slightest threat of
violence so seriously.
It's why we confiscate weapons and punish or
expel those who carry them on campus.
It's why we try to make our high school
campuses drug and alcohol free.
It's why we have prom buses and Grad Night
and take other measures to keep our students
from driving each other around drunk.
It's why we don't (or shouldn't, anyway) tolerate
bullying.
Why we take our students' emotional health -and any of their suicidal thoughts -- so
seriously.
It's why, here in California, the earthquake
safety standards for new school construction are
so stringent.
It's why, as a matter of fact, high school athletic
authorities require football pads and helmets to
meet and be maintained to a high standard. It's
why we have medics at football games. It's why
we now have rules about how soon young men
can play after a concussion and why many
football coaches are required to be educated
about concussions.
But new evidence suggests that so-called "subconcussive" head trauma can also be destructive
to mental health. And even if that evidence is
less than conclusive -- and I'm not saying it isn't
conclusive -- don't we usually err on the side of
caution where our children are concerned? For
example, if we think that maybe one of our
students is the victim of child abuse we are
required by law to call the authorities. If we
think that maybe a student has brought a
weapon to school, we search that student. If
there is a shooting five blocks from our school,
we're probably going to have a lockdown.
This troubles me. It troubles me not only
because it seems a double-standard and because
it raises the obvious (probably rhetorical)
question -- does the ten billion dollars of annual
college and professional football and the fact
that the NCAA and ultimately the NFL rely
almost entirely on high school football to
provide them with players? But it also troubles
me because I understand the value of high
school sports -- as motivating and characterbuilding and community-building activities. I
understand that in the part of Los Angeles where
I teach and coach, high school football is,
among other things, a gang-prevention program.
So if lives are at stake from the risks of football
then they may also be at stake if high schools
stop playing it.
And, yes, there are injuries in almost all sports
but in every other high school sports the serious
injuries are accidents and mishaps. In football,
head-to-head combat -- and all the short- and
long-term consequences -- are a natural part of
the game played the way it is intended to be
played. Leading with one's head is effective. It
is cheered. And, according to what neuroscientists are now saying, it is potentially and
ultimately deadly.
Perhaps the game of football in general and high
school football in particular can be made safer.
Perhaps it already has been -- with all the
elevated awareness about concussions and headtrauma -- but I don't believe anyone can say,
with certainty, that we are not putting all those
young men playing the sport at risk. We really
don't know if the game is just inherently too
violent.
The National Football League may never
sincerely act in the long-term interests of its
players, all of whom are consenting adults
(though they all started playing long before they
were). But high schools -- many of which
prohibit skateboarding on campus for safety
reasons! -- have a moral obligation to put
student safety above all other considerations.
If playing football has a high risk of long-term
permanent brain damage, how can any
education institutions -- high school or, for that
matter, college -- allow its students, whose
minds have been entrusted to us, to subject
themselves to such damage in the name of those
institutions?
High School Football Players Often Not
Deterred by Head Injury
Knowing dangers of concussion not enough to
keep many teens on sidelines, survey finds
MONDAY, May 6 (HealthDay News) -- Many
U.S. high school football players say they would
keep playing after experiencing a concussion,
even though they know it would put them at risk
for serious harm, a new study reveals.
The findings suggest that educating players
about concussion may not be enough to keep
them safe after they suffer this type of brain
injury, according to the researchers.
The study authors surveyed 120 high school
football players in the Cincinnati area and found
that one-quarter of them had suffered a
concussion, and that more than half said they
would continue to play even if they had
concussion symptoms.
Seventy percent of the players had been
educated about concussion and most of them
could identify common signs and symptoms,
such as: headache (93 percent); dizziness (89
percent); difficulty remembering and sensitivity
to light (78 percent); difficulty concentrating (76
percent); and feeling like they were in a fog (53
percent).
The study also found that 91 percent of the
players understood that there was a risk of
serious injury if they returned to play too
quickly after a concussion, but only half said
they would always or sometimes report their
concussion symptoms to their coach. Some even
said that athletes with a concussion have a
responsibility to play in important games.
There was no association between players' level
of knowledge about concussion symptoms and
their attitudes about the injury, according to the
study to be presented Monday at the Pediatric
Academic Societies' annual meeting in
Washington, D.C.
"In other words, athletes who had more
knowledge about concussions were not more
likely to report symptoms," study co-author Dr.
Brit Anderson, a pediatric emergency medicine
fellow at Cincinnati Children's Hospital Medical
Center, said in an American Academy of
Pediatrics news release.
"These attitudes could leave young athletes
vulnerable to injury from sports-related
concussions," Anderson said.
"Although further study needs to be done, it is
possible that concussion education alone may
not be enough to promote safe concussion
behaviors in high school football players," she
concluded.
Football continues to dominate high school
sports despite concussion risk
retired players with five or more seasons in the
NFL are four times as likely as other men their
age to die of Alzheimer’s disease or Lou
Gehrig’s disease deter parents from letting their
kids play cornerback or outside linebacker?
“There’s certainly some concern going forward,
are you able to keep these same kinds of levels
of participation?” Howard continued. “From our
standpoint, we write playing rules for high
school sports and that’s our number one priority
— trying to minimize the risk of injury for those
playing the sport.”
By Joshua Rhett Miller
September 08, 2012 | FoxNews.com
Just as it does with American sports fans and on
the big screen, the pigskin reigns supreme in
high school sports.
Despite well-established health risks and an
increasing number of former NFL players
suffering memory loss, the number of high
school football players continues to dwarf
participation in other sports, namely track and
field, basketball and baseball. In 2011-12,
nearly 1.1 million American boys played on an
11-player high school squad, compared to just
575,628 athletes who pounded the track and
535,289 who played basketball, according to the
National Federation of State High School
Associations (NFHS).
“It is the sport in our country, and it’s been
sitting there for a long time — for ever and
ever,” NFHS spokesman Bruce Howard told
FoxNews.com. “It’s like soccer in other parts of
the world.”
Indeed, football’s dominance among U.S. sports
is well-established, with more people tuning in
to watch Wednesday’s season debut with the
New York Giants and Dallas Cowboys than
those who watched the Democratic National
Convention. But will new studies that found
An estimated 67,000 diagnosed concussions
occur during high school football games each
year and at least 50 youth football players from
20 different states have reportedly died or
sustained serious head injuries on the gridiron
since 1997.
Howard said safety of the game has improved
by “light years” from a generation ago, but
acknowledged that injuries will continue to
occur in the often-brutal game.
“It’s a collision sport,” he said. “You’re not
going to play the sport without having those
types of issues.”
More than 3,000 former NFL players have sued
the NFL over claims that it did not properly
warn them of the dangers of head injuries and
the long-term consequences of repeated, violent
blows. One of those players, Brad Culpepper, a
defensive tackle who played eight seasons with
three teams, told FoxNews.com that while he’s
concerned for the safety of his son who now
quarterbacks his high school team, there’s no
way he’s keeping his kid off the field.
“As a parent, I’m obviously concerned about
what all of my kids do in terms of their health
and academics, but the coaches and trainers
around high school football and the NFL are
much more aware of the problem now,” said
Culpepper, who now a personal injury attorney
in Tampa, Fla. “Am I worried about it? It’s not
something I think about frequently. I have no
problem with him playing.”
lot of times, the technique for blocking and
tackling, they don’t understand very well. So,
they are at a little bit of a higher risk because of
their skill set.”
Throughout his career, Culpepper, 43, said he
experienced “hundreds” if not “thousands” of
concussions as a lineman who smashed
opposing players with his head and hands on
every play.
And while some recent studies have shown
increased numbers of concussions among
teenagers, that’s likely due to better tracking and
diagnoses, Shields said. Furthermore, the
common conception that one massive blow is
the thing to watch for isn’t exactly true.
Multiple hits over time can be just as damaging
to the brain, he said.
“If you weren’t seeing stars after a hit, it wasn’t
a good hit,” he told FoxNews.com. “Good luck
getting separation from a 300-pound lineman
while not using your head and hands. Every
single week I would see a grid or stars at some
point.”
“So if you get dizzy, that’s level one of a
concussion,” he said. “And that’s what’s
happening now.”
Culpepper, however, insists the specter of longterm injury what keep his son Rex — or others
across the country, for that matter — from
playing football.
Unlike Culpepper, Hall of Fame quarterback
Warren Moon, whose grandson now plays
football, told Fox News Radio he is worried
about serious injury on the field.
“I don’t think the concussion situation will have
any effect on the popularity of football,” he said.
“Football is king in this country. I think being
aware of concussions is going to make for a
better game and that’s what [NFL
Commissioner Roger] Goodell wants.
“My biggest concern was the league he was
playing in, who he was going to be coached by
and if he was going to be coached properly,”
Moon said. “You’re never going to see injuries
in football or concussions in football go away,
it’s a collision sport. Things are going to happen
by accident sometimes, heads are going to
collide, but if you can cut down on those
numbers, you’ll make a lot of improvement in
the game.”
“Am I worried about him? I’m worried about
him throwing an interception,” he said. “He’s a
tough kid. He’ll get hit in the mouth and he’ll
pop right back up.”
Dr. Clarence Shields, an orthopedic surgeon
who specializes in sports medicine in Los
Angeles, told Fox News Radio that teenage
athletes are still learning to use their bodies,
potentially putting them at an increased risk of
injury.
“Athletic skills will sometimes protect you from
getting hurt,” he said. “Anybody can try out for
the football team — whether you’re really good
or aren’t very good doesn’t really matter. And a