I love football. I played when I was young. I appreciate the beautiful ballet of violence. Yes, I really understand and appreciate the game. Since I live in the Pacific NW, I’ve become a fan of the Seattle Seahawks and I’d love to see them win another Super Bowl. But I’ve been wondering if I should boycott football.

I know that lots of people are talking about boycotting the NFL. The current discussion centers on the take-a-knee protests of racial inequities in the justice system. Taking a knee for justice reform and better policing started with Colin Kaepernick. After taking a knee last season, Kaepernick is not employed this year. The first call to boycott I saw concerned Kaepernick not being hired this year. Some are concerned that the owners may have colluded and refused to hire the quarterback. These people have suggested boycotting the NFL because the owners are silencing a call for racial justice. Other people want to boycott because players are continuing to protest those same racial injustices. President Trump suggested last week that players taking a knee should be fired and has called for people to boycott the NFL. Many people have echoed this call. (I will address the take a knee protest in my next blog post.)

But why am I considering a boycott?

I wonder if I should boycott until the NFL, and every level of football, does a better job of protecting players. Players should not have to sacrifice their brains to play a game and earn a living. In essence, I am concerned with the other part of Trump’s comments on football. He worried that the game isn’t violent enough. He suggested that the rule changes, designed to promote player safety, were ruining the game.

This is why I have a problem with continuing to support football. I’ve become more and more concerned about the impacts of repeated head injuries. The data about concussions and head injuries have been piling on for a while.

At one time, concussions in football were assumed to be isolated events. I experienced this personally. I received a concussion when I played high school football. I was banged up pretty hard in practice. From what I was told, I wobbled off the field (I don’t remember that day at all). Luckily, the coaches didn’t put me back in the scrimmages that day. In fact, they didn’t let me drive home after practice but instead made sure I got home safely and told my parents I’d received a concussion. Of course, I was back out there the next day at practice, putting my brain at risk. Fortunately, I didn’t get any more serious hits that week or the rest of the season. Best practice now would have kept me off the field for several days and perhaps weeks.

Why should I have been kept off the field? Because of the amount of time that the concussion lasts. The effects of concussions on cognitive abilities last several days and often longer than a week (McCrea et al., 2003). Athletes should receive assessments for several days to determine when they have returned to baseline. Only after that time should the person be allowed to engage in contact. But even that may incur risks. Although deficits may not appear on standard cognitive measures, neurological brain imaging may continue to show evidence of changes after cognitive performance returns to normal (Jantzen et al., 2004). Just because the person seems to have returned to normal does not mean that brain functioning has completely recovered.

Even waiting may not be enough. Walking back on the football field after a first concussion puts the player at risk. We know now that additional head injuries after receiving a concussion are problematic. The evidence on the cumulative effects of concussion is relatively clear. For example, Iverson, Gaetz, Lovell, and Collins (2004) looked at the cognitive performance of amateur athletes who had received concussions. The interesting part is that they compared the performance of people for whom this was their only concussion with individuals who had earlier concussions. The people with multiple concussions displayed substantially greater cognitive impairments than people for whom this was their only concussion. The impacts of concussion pile on.

The most recent evidence on this point is completely disturbing. In a recently published paper, Mez et al. (2017) looked at the brains of deceased football players. They were looking for the impacts of repeated brain trauma: Chronic Traumatic Encephalopathy (CTE). By studying the brains, the researchers found compelling evidence of neurodegeneration, the death of brain cells. The vast majority of the deceased players showed signs of CTE: 177 of 202 or 88 percent. The effects were dose-dependent. The more football an individual played, the more likely they were to have CTE. The effects were particularly strong for people who played college and professional football. CTE has significant impacts on daily functioning: decreasing memory and cognitive abilities, changing personality and impulse management.

This leads to the two questions in my title. First, should you let your child play football (or other sports that include high rates of concussions)? Luckily for my wife and me, our sons did not ask to play football. We didn’t have to choose. I would have tried to talk my sons out of playing. By the time they were in school, the evidence was clear about the risks of repeated head injuries. I didn’t want them to play a game that I had loved playing. I am happy they chose other activities. I can’t tell you how to respond, but you should consider the long-term risks.

My second question is: Should I watch football? I know that at all levels of the game, coaches and organizations are trying to do a better job of protecting players and their brains. I worry it isn’t enough.

References

Iverson et al. (2004). Cumulative effects of concussion in amateur athletes. Brain Injury, 18, 433-443.

Jantzen et al. (2004). A prospective functional MRI study of mild traumatic brain injury in college football players. American Journal of Neuroradiology, 25, 738-745.

McCrea et al. (2003). Acute effects and recovery time following concussion in collegiate football players. JAMA, 200, 2556-2563

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