Participation in youth leagues has fallen nationally thanks to a growing awareness of the risks of head injuries. But medical and sports officials say much more needs to be known about this ‘one-size-fits-no-one’ issue.
Hugh McSorley, 16, has already suffered three concussions, two of which occurred during high school football practices, the other from a motorcycle crash. He was still feeling headaches last fall but wanted to continue playing for the Scarborough Red Storm.
OPINIONS OF SPECIALISTS
We asked some medical experts what advice they would have for parents wondering if they should let their children play tackle football. Here are the responses:
“If it were my little kid, I would make sure that the helmet is fitting snugly and do some neck strengthening exercises, even when they’re younger. We’ve really got to protect these kids, because they’re treasures and we can’t afford to exploit them.”
– Aynsley Smith, associate professor of orthopedics, Mayo Clinic, Rochester, Minn.
“At that level, younger than junior high, they don’t need to play tackle football. They need to learn positioning and foot skills and you can do that with flag football. There’s absolutely no reason these kids are tackling. We don’t know the age limit. I think less than junior high, they probably shouldn’t be doing tackle football. But in junior high, it’s probably OK, I’ve seen concussions in children younger than 8 from football. The problem is I have a really tough time dealing with them. It’s hard to evaluate them. It’s hard to test them, and they’re slow to recover.”
– Dr. Bill Heinz, Portland
“I don’t think kids should be playing collision sports below the age of 12. I think it’s just setting us up for problems. I think Pop Warner needs to get out of playing tackle football from ages 6 to 12, but that’s just a personal opinion. There’s no science behind this. We don’t know what having a concussion in any age means for the rest of your life. Period. None of that data is available.”
– Dr. Paul Berkner, Colby College
“I don’t think I could tell somebody not to play football or another sport. However, I would definitely do my best to educate them – these are the risks, these are the things you can do to try to prevent yourself from being injured. But it’s like anything else, you can slip and fall outside. Am I going to tell you not to play basketball because you might sprain your ankle? Everything that you do has risks.”
– Lisa Favreau, athletic trainer, Cape Elizabeth High School
to learn more
• For more information about USA Football’s safer tackling program, visit:
http://usafootball.com/headsup
• For general information about concussions, how to prevent, diagnose or treat them, visit:
www.mayoclinic.org/diseases-conditions/concussion/basics/definition/con-20019272
Additional Photos
Mom put her foot down.
“I was like, ‘No, it’s not worth it,’ ” said Denise McSorley, a nurse. “At first, he was disappointed. But he now does track and field, and he actually found his niche. He’s really good at shot put and discus. It’s safer for him. What’s scary are the ones who continue to play football.”
Football has been America’s most popular sport for at least two generations, based on participation at the high school and youth levels, hardcore fan interest and hefty television contracts. But concussions, and the fear of them, are driving the conversation these days, from parents who are deciding not to let their young sons play the sport to former NFL players who are suing their league because of the lingering brain trauma they claim they were never warned about or properly protected against.
After decades of steady growth, participation is declining at both the youth and high school levels. Officials with Pop Warner, the oldest youth football league in the nation, reported a 9.5 percent reduction in players from 2010 to 2012, the most-recent statistics available. The number of high school players in America fell by 22,000 (about 2 percent) in that same period, although it remains the sport with the highest rate of participation.
The decline is not universal, as evidenced by a southern Maine community that took the rare step this winter of adding a second season of indoor football for a team of third- and fourth-graders. But the conversation in living rooms in Maine and across the nation is changing as families weigh a son’s devotion to football against the possibility that the sport could end up ravaging his brain.
The NFL originally settled its lawsuit with some 4,800 former players for $765 million, but a U.S. District Court judge in Philadelphia struck it down in January, fearing it was not enough money to cover all the future claims that might be filed. And it’s not just the living former players who have a stake.
Cheryl Shepherd has sued the Kansas City Chiefs for wrongful death after her son, former University of Maine player Jovan Belcher, killed his longtime girlfriend and then himself in December 2012. Shepherd claims that he was subject to “repetitive head trauma” and didn’t receive adequate medical attention. She had her son’s body exhumed this winter so his brain could be checked for chronic traumatic encephalopathy, or CTE.
Such ugly publicity is a sobering jolt for a league that has a stated revenue goal of $25 billion by 2027.
Concussions have put football at a crossroads, and most agree that something needs to be done to alleviate the risk. But what, exactly? And what are the consequences for those still playing?
“The kids are young, the brains are young. It’s a damage that you can’t see all the time,” Denise McSorley said. “Even a minor hit can cause one.
“I think they can make it safer. I don’t know that they can ever make it completely safe.”
‘FOOTBALL … IS THE POSTER CHILD’
Dr. Paul Berkner’s office at Colby College in Waterville is the nexus for the debate in Maine. Berkner runs the Maine Concussion Management Institute, and he and his colleagues are attacking sports concussions head-on.
“We were seeing concussions across every sport. Everybody automatically goes to football, because it is the poster child for concussions,” Berkner said. “You can’t watch a football game on TV today without seeing some man getting concussed. Period. And we could always see it before, but we didn’t pay attention to it.”
Soccer, hockey, basketball and lacrosse also see their share of concussions. But football is where the concern began and where it largely remains.
Former Pittsburgh Steelers center Mike Webster, who died at age 50 in 2002, was the first player revealed to have CTE, with his brain essentially showing the same traits as someone suffering from Alzheimer’s. Concussions, and the violent aspects of football, have been a matter of debate ever since.
Pop Warner organizers cited concussion fears as a reason for the decline from 250,000 players in 2010 to 225,000 two years later.
Bob Colgate of the National Federation of High Schools stopped short of saying concussions are why participation is down in high school football.
“The feedback we’re getting from our states is that it probably is related to the concussions. But we’re not drawing that conclusion yet, because enrollment is down and kids are specializing,” Colgate said. “With the economy right now, some families can’t afford more than one sport. We’re not in panic mode yet.”
There may not be panic, but reminders of the issue come every day.
Two weeks ago, Indiana became the first state to require training in concussion awareness for all high school and youth football coaches and to mandate a 24-hour waiting period for any player suspected of suffering one. The Indiana Department of Education will provide the training, which coaches would need to pass every two years for a fee. (Maine passed a law that took effect last January requiring all high schools to develop a policy for managing concussions for all students.)
The NFL recently announced a $45 million commitment to the Heads Up Football program that teaches safer tackling techniques to young athletes. Former Steelers Coach Bill Cowher, who is on its advisory committee, touted its virtues in a letter aimed at parents.
BETTER TACKLING TECHNIQUES
Those are just two recent examples of the way concussions and football are constantly linked.
And that is wearing on some youth football coaches in Maine. The state does not have Pop Warner teams. Rather, individual communities or regions oversee youth football leagues.
The number of children playing in Maine is impossible to ascertain, but a spot check of several leagues revealed it is fairly steady, with some leagues reporting a slight increase, others a slight decrease.
Jim Hartman started a youth football program in Portland a quarter-century ago. Now the coach at Portland High School, he still keeps tabs on the sport at the lower levels. The mention of concussions sets him off.
“The concussion issue is a sore spot for me. I realize the importance of concussions and have seen both ends of it, the light ones and the ones that are pretty major. But at the same time, I think football is taking an incredibly bad rap on this,” Hartman said. “I think all sports have concussions. But with the newspapers and what’s going on in the NFL, all you hear about is football.”
Hartman said when he was younger, athletes were expected to play through head injuries. He realizes that was wrong, and treats them as serious injuries now when he sees them, which isn’t often.
“We had three last year and one or two this year,” Hartman said. “It’s such a non-significant thing, I don’t even talk to our trainer about the rates of concussions and such.”
Mark Pettingill was a defensive back at the University of Maine in the 1980s, has coached the sport for 14 years and currently is president of the Southern Maine Youth Football League. He, too, has seen attitudes toward concussions shift, and for the better. The biggest improvement has been teaching better tackling techniques, with defenders keeping their heads up to avoid jarring hits to the helmet.
“Back then, you tried to tackle someone as hard as you can. Your helmet was more of a weapon. Now, research and awareness has changed so much. It’s just fantastic. I had concussions myself due to poor tackling techniques,” Pettingill said.
YOUNGSTERS BUCK A TREND
Youth football numbers may be down in much of the nation, but one team in southern Maine is bucking that trend by extending the season into March. Skip Winter formed the Seacoast Lobsters – a group of 17 third- and fourth-graders that includes his son, Grant – to play in an indoor football league based in Eliot. The team, which just finished its inaugural season, practiced twice a week and played on Saturday afternoons in a bustling facility in Bedford, N.H., with four games happening simultaneously.
All in full pads.
Winter said the original plan was to find a team for a couple of local kids who didn’t want to play other sports in the winter. Then he discovered there were enough parents and children interested in forming an entire team for the 8-on-8 league. The appeal was getting more competition for their sons so they could improve their skills against other boys who were just as dedicated to the sport. A friend who works for Nike arranged for a sponsorship that included all the equipment except for the shoulder pads and helmets.
Just like that, the boys were playing another 10 weeks of football.
“It’s faster. The kids are bigger,” Winter said. “There’s no weight limits; we’re playing against kids that are 150 pounds. But all of our kids, particularly the third-graders, have ramped up their play in a huge way.”
At a practice in York this winter, it was apparent this was a serious undertaking for those involved. It started with push-ups and other calisthenics, progressed to individual drills and concluded with a scrimmage. At one point, an exasperated coach was heard admonishing the boys: “Come on, be professional here.”
The children all play in a fall league as well. Some wrestled last winter and others balanced basketball with their new football obligations. But all of them really wanted to focus on football, Winter said. That included his son, a third-grade fullback and defensive tackle for the Lobsters. Grant also dabbles in lacrosse, but said football is his clear favorite.
“I like it,” he said of getting to play a second season of football. “I’m getting better. We’re all getting better.”
Winter, assisted by seven other fathers in the coaching duties, plans to add a fifth- and sixth-grade team next year. The demand for more football is there, he said.
“The amount of experience these guys are getting just from this season, it’s going to be evident when they get back for the rec league,” Winter said. “The competition they’re seeing is probably twice as good as what they’re going to see in the fall.”
Winter said he wasn’t worried about increasing the risk of injury. His players emerged from their winter season healthy.
“The advantage of having eight coaches is that you have eight coaches that are hands-on. Our defensive coaches are really good about teaching heads-up tackling,” Winter said. “I also think at this age, not that it couldn’t happen, but the speed isn’t there and the size isn’t there yet. It never dawns on me. You can get a concussion playing basketball or lacrosse or whatever.”
‘WE WANT TO BE CLEAN-CUT’
This is not the first time football has come under scrutiny for its level of violence. In 1905, a year in which 18 players reportedly died well before professional football even existed, there was a cry to abolish the sport. President Theodore Roosevelt stepped in, inviting three top college coaches to a White House summit, out of which the National Collegiate Athletic Association was born.
The biggest rule change, back when players didn’t wear helmets, was the introduction of the forward pass. This took the sport beyond a sequence of rugged scrums into something with more finesse, in which speedy athletes could find more room on the field to elude defenders.
The mayhem subsided and the sport flourished. But there has always been a brutal ethos to football, a celebration of hard collisions perpetrated by hard-nosed men.
It’s an attitude that was on full display this winter when the Esquire cable network debuted “Friday Night Tykes.” The reality show followed a San Antonio football league made up of 8- and 9-year-olds. But the real revelation was the coaches who were shown instructing the children where to hit opponents to produce maximum damage (the ear hole of their helmets) and leading them in profane chants. The initial episode drew 428,000 viewers.
It’s an image of the sport most coaches are desperate to wash away.
Jim McDonald is president of the Maine Youth Football League and coach of its South Portland entry. He got his league involved in the Heads Up Football program last year, paying the $25 fee to take an online course that shows coaches how to teach safer tackling techniques and how to make sure equipment is adequate and fits properly.
McDonald is mandating such instruction for all of his league coaches. He wants to require each home team to provide medical personnel responsible for diagnosing concussions, among other injuries. He traveled to Indianapolis last month for an NFL-sponsored discussion about what steps can be taken to reduce injuries.
“Football’s a great sport, and we don’t want recklessness. That’s not the game I want in the league. We want to be clean-cut. We’ve got great ballplayers in Maine,” McDonald said.
“Our numbers could be bigger, and I hope they climb. I didn’t see as many (concussions) in 2013 as I did in the previous year. I noticed the tackling was a lot better. They were tackling down around the legs and the waist. Runners weren’t lowering their heads.”
In Portland, Jay Lowe noticed a decline in seventh- and eighth-graders playing football in recent years. Lowe, the youth league’s vice president, is not sure if that’s a result of concussion worries, but he’s not taking any chances.
The league has a local doctor speak to coaches each year. It is in the middle of a $50,000 fundraising campaign to buy state-of-the-art helmets for all of the players on the eight tackle football teams it sponsors. There were four no-contact, flag football teams last season for kindergartners and first-graders. Next season, that option will be expanded to include second- and third-graders.
Lowe estimated there were three concussions last year in the Portland league, the largest in the state with 210 participants. He acknowledged the safety concerns will be hard to dispel.
“We’ve got a big job ahead of us educating our coaches. Football is a competitive sport and it’s hard to pull your star player out of the game. You might just think he got his bell rung,” Lowe said.
“It’s kind of reinventing how coaches look at the game. You’ve got to have a coach that’s willing to say, ‘Johnny, go to the sideline.’ ”
HELMETS CAN’T SOLVE PROBLEM
Medical experts say all of these responses – from handing out harsher penalties for hits to the head, to teaching better tackling techniques, to focusing on high-tech helmets – are terrific first steps. It’s just that there’s no way to know if any of them will curtail concussions.
The de-emphasis on helmet-on-helmet tackles may take a generation to fully take hold, for example.
The equipment issue is particularly tricky. Football helmets – like motorcycle helmets – were initially designed to reduce skull fractures. And they worked.
But concussions happen inside the skull. The brain is floating in cerebral spinal fluid, and when the head suddenly lurches violently and then snaps back, the brain is sent crashing off the inside of the skull. This happens when there is a direct blow to the head, or when there is a whiplash motion. A helmet cannot prevent that from occurring.
“They think more like, ‘Well, I’m wrapping up a package that I’m shipping UPS, so if I put more padding on it, it’s not going to break,’ ” said Dr. Bill Heinz of Portland. “That’s not how it works. There’s nothing you’re going to do to put the brakes on that brain.”
Heinz, like Berkner, was a driving force behind forming the Maine Concussion Management Institute in 2009. Frustrated that there was no consistency about how the injuries were being diagnosed or managed in Maine, he decided to get serious about instituting a standard protocol, at least in the state’s 160 high schools. The focus had to be on getting concussed teenagers back to their schoolwork, not necessarily the athletic fields.
“We talk about a return to function, return to learning. I’m more interested in getting them back in the classroom than getting them back on the football field,” Heinz said. “If they never play football again, so what? But they’ve got to get back in the classroom.”
The difficulties are enormous. Heinz said diagnosing a concussion on the spot can be troublesome, even for trained doctors. It’s not as if every athlete who suffers one appears wobbly and glassy-eyed. Sometimes, the adrenaline of competition allows them to mask it temporarily. Other times, it doesn’t fully manifest itself until the next day.
MAJOR STEP FOR HIGH SCHOOLS
The current standard is to give athletes a test at the outset of their season to establish a baseline of their cognitive and motor skills. The test resembles a video game, but reveals a great deal about the child’s brain. If a concussion is confirmed, the student cannot return to action until he or she is back to that baseline performance level.
That has been a big step for local high schools. But Heinz said there is still so much left to be learned about brain injuries. Namely:
• Genetics appear to play a role. Why are some people more likely to suffer a concussion than others?
• Why do female athletes get concussions at a higher rate than males?
• Someone who suffers two concussions is more likely to get a third. And it appears that even a first concussion increases the likelihood of a second. Is that because of the nature of the injury, or is the individual more likely to be a reckless player in the first place, prone to putting his or her head in harm’s way?
• The most visible concussions involve athletes who absorb a single, wicked collision. But there are also players, like former NFL player Mike Webster, who get them as a result of a sequence of subconcussive blows, year after year. How can those be diagnosed sooner and prevented?
• And the younger you are when you suffer a concussion, the longer the recovery time. High school athletes need more time than collegians, who need more time than professionals. But what are the long-term impacts of a concussion at any age?
“It’s one size fits no one,” Heinz said, succinctly, about the vagaries of brain injuries. “We don’t know the long-term effects. We don’t know how many is too many. We don’t know how these kids would progress if they hadn’t had a concussion. Would they end up at Harvard Law and instead they can’t even graduate from high school? That’s the big problem with this injury.”
CAPE ELIZABETH’S ‘TEAM MOM’
Heinz is part of a wide range of doctors and medical researchers trying to figure out what can be done to combat concussions. On the other side are the coaches who have devoted their lives to teaching the sport they grew up playing to a new generation of athletes. Those two groups rarely interact and seem leery about the motivations of the other.
In the middle are athletic trainers like Lisa Favreau, who must stay updated on the latest in concussion treatments while working with coaches to try to keep players from becoming the latest victims.
Favreau has tended to the athletes at Cape Elizabeth High School for the past 10 years. It is a part-time job. It can be a thankless one, too.
But Cape Elizabeth is regarded as the standard-bearer among Maine high schools for how concussions should be handled. Favreau documents each occurrence, and is dogged in making sure that students don’t return to the classroom or the locker room until they have fully recovered. She has the respect of doctors like Heinz and Berkner. The Cape Elizabeth coaches good-naturedly refer to her as the “team mom.”
On the door and wall in her makeshift office at Cape Elizabeth are posters about the symptoms of concussions and how to avoid the injuries.
In her second year at Cape Elizabeth, 2005-06, Favreau said she treated 15 concussions. As she learned more about recognizing the injuries, that number tripled. In the fall of 2011, for example, she diagnosed 21 concussions. Some years, football is the biggest culprit; other years, it’s soccer.
This year has been a light one for concussions so far, although Favreau isn’t sure why. She hopes it’s the beginning of a trend.
“We teach kids how to tackle properly, how to head the ball (in soccer) properly,” Favreau said. “The coaches have been understanding. They get a little frustrated, as usual, because even with an ankle sprain, they want their kids healthy and out there. But they’re understanding.”
Favreau is present at most football practices and all home games. She gets another trainer to cover road games because she also tries to be at soccer matches and other sporting events. When an athlete gets hurt, she is the first responder. She is the one who pulls the student from competition if she suspects a concussion, who sends him or her to a doctor for the ultimate diagnosis.
“It’s a very subjective injury, because they may look completely normal on the outside and appear absolutely fine. But on the inside they’re jumbled and they’re not quite feeling normal,” Favreau said. “I’ve had kids wait two weeks before they even said anything. You have to be alert. I do encourage teammates to rat each other out if there’s a significant injury going on, because it’s for their safety. I tell the athletes, I can’t fix your brain. That’s the one thing I can’t fix. And so we need to be careful with it and we need to protect you so that way later on in life you’re not having issues. They’re slowly coming around.”
ONE ATHLETE’S EXPERIENCE
Billy Parker started playing football as a third-grader in Massachusetts. He became good enough to have most small colleges in New England desire his services. He chose Colby College in Waterville.
At 6-foot-3, 230 pounds, Parker was in line to be a starting defensive end as a sophomore last fall. Then he discovered what so many football players have. They may be bigger, stronger and tougher than the average human being. But their brains are just as vulnerable.
On Sept. 1, during the seventh practice of the summer, Parker used the left side of his body to take on a pulling guard. He absorbed a face mask to the ear hole of his helmet and felt that half of his body go numb, from his arm to his toes. Parker spent 10 minutes letting that sensation subside, then returned to practice. Later, he tackled a running back and their helmets slammed into each other.
“At that point, I was really feeling it in my head. I just assumed it was dehydration. It was a long, hot practice,” Parker said.
In the evening, the players gathered to watch film. Parker couldn’t focus. The images in front of him were a blur and his coach’s words seemed to float into the air. He couldn’t fall asleep until 3 a.m., and had to wake up at 5:30 for another team meeting. When Parker tried to get up, he was overwhelmed by dizziness and fell back into bed.
He told his defensive line coach something was wrong. He was sent to the team trainer, then the college health center, where he got the official diagnosis – concussion.
Parker said, in retrospect, he may have suffered a previous concussion as a high school basketball player. It was never diagnosed, and he doesn’t remember hearing much about the topic during his sports career. At Colby, his condition deteriorated. He couldn’t function in the classroom, had trouble sleeping and eventually was sent home, missing a semester of classes that he’d already paid for.
Parker saw a concussion specialist in Boston and started to fear the worst about his future on the gridiron. He returned to Colby in the winter, but kept visiting his Boston doctor periodically. Finally, on Feb. 25, his doctor broke the news to him.
He would never play football again.
“I had about five months to prepare for this,” Parker said. “I just said, ‘Yeah, you’re right.’ But come August, it’s going to hit me. It’s really going to hit me when the team’s running the conditioning tests and I’m standing watching.”
Parker, like Scarborough’s Hugh McSorley, has taken up track and field at Colby, determined to keep his competitive juices flowing somehow. But it’s not the same. And he is skeptical that he will ever be the same, either.
Parker wants to be either an actuary or an engineer. But when he studies these days, he can’t concentrate for more than 45 minutes at a time. His mind wanders. He finds himself making “stupid mistakes” on assignments.
“The way I kind of see it, I’m not 100 percent of the way to where I was before the injury. But I feel like this is my new 100 percent. I don’t feel like I’m going to get any better than I am right now,” Parker said.
Prominent retired NFL quarterbacks like Kurt Warner and Brett Favre have said they would have second thoughts about letting their sons take up football. President Obama has said the same.
Parker’s experience reveals the conflict between the savageness and the beauty of the sport, why it is beloved by so many even as it debilitates a few.
Shortly after Parker suggests that he never expects to be wholly functional again, he is asked if he would allow his son to play football should that time come.
“I would support him 100 percent. In third grade, in ninth grade, as a senior, whenever he wanted to play,” Parker said. “I was taught very good technique and I played for 10 years and I had one concussion, and it happened on a freak play. I would want to be the one to coach and teach him, but yeah, absolutely.
“I still love football.”
Mark Emmert can be contacted at 791-6424 or at:
memmert@pressherald.com
Twitter: MarkEmmertPPH
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