We can make football safer

Several years ago, I was at football practice in high school where I was working with the team on a concussion research project. The players were lined up in two lines facing each other, and as the coach instructed, “whistle, hit the man opposite,” a serious worry rushed through my mind.

Professional sports get the lion’s share of attention, but concussions are a significant medical problem at all levels of play. Although approximately 1,700 athletes play professional football each year, more than three million children and youth in the United States play the same game. This makes concussion a major public health concern in homes from coast to coast.

For decades, athletes, parents, coaches, and medical professionals viewed concussions as a temporary injury with no long-term consequences. Athletes usually played through it as a sign of toughness. Our ideas about concussion changed around 2005, when Brain Tissue Pathology reported Mike Webster, retired National Football League player, was published. The report was the first to identify chronic traumatic encephalopathy (CTE) in a football player and suggested the condition was related to concussions the player sustained on the field. Since then, public attention has focused on this link between brain injury and blows to the head, with much of the discussion centered on football.

Participating in any sport involves the risk of injury, and concussions are always part of that calculus. This was never more evident than at the start of the 2022 season, when Miami Dolphins quarterback Tua Tagovailoa suffered a concussion against the Cincinnati Bengals and his sprained arm was on full display in front of a national audience. Concussion prevention and treatment is now better than ever, but with all sports out of the way, we need to do more to prevent them. This means improvements in equipment, better training for coaches and players, and better medical care.

In the early 20th century, football was played without helmets, but serious injuries such as skull fractures led to occasional leather helmets in the 1920s. The plastic shell helmet was invented in 1939 and became mandatory a few years later. The first face mask came into play in the 1950s, and foam padding wasn’t added until the 1960s. Over the years, engineers have updated the basic design with older face masks and newer internal padding such as air bladders and gel pads. Until recently, these changes were made to reduce the most serious brain injuries, such as brain hemorrhages and skull fractures, and have been largely successful. But as our understanding of concussion evolved to understand its significance as an injury, so did the scrutiny of player equipment.

The basic problem is that no matter how much the impact force is reduced by protective gear, we cannot stabilize the brain inside the skull after a crash – making a concussion resistant helmet a likely impossible technical challenge. However, that hasn’t stopped helmet improvements. Virginia Tech researchers have introduced a new eye for concussion prevention helmet classification system for concussion risk in 2011. A five-star system (one being the worst, five being the best) evaluates the helmet’s ability to reduce the risk of concussion. This gives consumers tangible evidence of making an informed purchase. In the first year, only one helmet received a five-star rating, but now there are more than 25 five-star helmets in the latest rankings. Modern helmets use advanced shell materials that flex under impact, have movable panels to absorb forces, and multi-layer padding that responds to different impact speeds. Companies continue to improve helmets as new materials become available the latest science.

But technical limitations shouldn’t prevent us from closely examining other factors that may reduce concussion risk. For example, in one study of head impacts and concussions during five college football seasons, nearly Fifty percent of concussions occurred during the four-week preseason; the rest occurred over the next 12 weeks during the season. Such information led the NCAA to reduce the number of preseason practices allowed. Others have shown that reducing numbers in high school football practices where contact is allowed reduces blows to the head by up to 46 percent. Moving the starting line forward to the 40-yard line decreased the number of times a receiving player runs the ball back. This is one of the riskiest plays in the game for a concussion.

As players get older and start playing contact football, the coaching staff needs to teach proper tackling technique – not leading with the head and wrapping the opponent with the arms. Learning how to do this correctly will increase your playing time (ie you can’t play if you’re injured). In addition, a medical provider involved in concussion management during practice and competition can help identify and quickly remove injured players, a known factor reduces injury severity and time away from sports.

While injury prevention is the best approach, concussions will always be a part of sports. This is bigger than football. This injury occurs in all sports and affects athletes regardless of gender. Women who make up about 45 percent of college athletes, usually report more concussions in sex-matched sportsbut represent only 20 percent of the medical literature. Some researchers have speculated that women are more likely to report their medical concerns to a health care provider, but they also they have smaller neck muscles relative to head mass, limiting their ability to stabilize their head upon impact. Some data indicate an increased risk of concussion at various points menstrual cycle. All of this suggests that concussions aren’t just in football, and unless we’re going to ban all sports, there’s an urgent need to continue our work to better understand concussions and how to prevent them.

In the meantime, several doctors and organizations have created concussion guidelines that did not exist in the early 2000s, and every four years a group of international experts convenes to review the medical literature and make recommendations about the best concussion care. The latest guidelines will be completed later this year. As with all advances in medicine, change is gradual and often difficult to detect, but concussion prevention and treatment is now better than ever. Nevertheless, many athletes will do almost anything to stay on the field and “play through the pain.” It is imperative to create a culture that supports athletes and encourages them to come forward when they are injured, empowers them to be advocates for their own health, and empowers them to protect overall brain health while playing competitively and safely.

Changes are happening in the way we approach sports-related concussions. In my 20 years of concussion research, I can attest that we now take concussion seriously as an injury, better understand impact biomechanics and other risk factors, work to prevent it, and improve the management and recovery process. Sports are an integral part of American culture, providing millions of children with much-needed exercise. As children grow into adults and make sports their hobby or even profession, it is important to ensure that they play safely at all levels.

This is an opinion and analysis article and the views expressed by the author(s) may not be the same Scientific American.