By Dev Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- Author Gregg Easterbrook recently published an excellent thought-provoking article in which he stated the risks of brain injury might be significantly reduced by banning tackle football until at least age 12
- One cited scientific study showed that contact sports participation was the highest risk factor for late development of chronic traumatic encephalopathy (CTE)
- Another cited study stated that starting tackle football before age 12 is a critical risk factor for later poor brain function
- Football may need to follow hockey and soccer’s direction in placing a minimum age on tackle football
Each month we see more published scientific data that allows us to dig deeper into the subtleties of concussion risk and outcomes. A recent Tuesday Morning Quarterback article in the NYT by Gregg Easterbrook suggests that the data to date is compelling enough that he is recommending a ban on youth tackle football. The article is provocative and thought provoking, and I recommend any parent of kids playing contact sports have a look.
Mr. Easterbrook forms his opinion from personal experience and also relies upon two recently published scientific studies.
The first cited study, from the Mayo Clinic and published in December 2015 was a study of brains with documented chronic traumatic encephalopathy (CTE). The take home message from this study: CTE was only found in men with a history of participation in contact sports. The authors concluded, ‘Exposure to contact sports was the greatest risk factor for CTE pathology.
I have a few thoughts on the first cited study. First, it’s a fairly small sample and other researchers with access to similar data would be helpful in validating the findings. Second, it’s a retrospective study meaning that the data was acquired by looking backwards (the study subjects were deceased) so it’s difficult to make completely accurate predictions about cause and effect based upon this data. And my third personal opinion takeaway: the findings are likely real, and they likely are predictive. We just need more data.
The second study sought to correlate age at which former NFL players started tackle football and their subsequent poor performance on standardized cognitive tests. This study, published in March 2015 is particularly relevant to young athletes. The authors tested 42 former NFL players, ages 40 to 69. The players took various cognitive tests to measure their brain function and were also asked questions about the age at which they started tackle football, number of estimated concussions, etc. The authors concluded that ‘There is an association between participation in tackle football prior to age 12 and greater later-life cognitive impairment measured using objective neuropsychological tests. These
findings suggest that incurring repeated head impacts during a critical neurodevelopmental period may increase the risk of later-life cognitive impairment.
In other words, they feel that if a boy starts playing tackle football before age 12 he is at greater risk of developing poor brain function as an adult than those boys who started tackle football after age 12.
My take on the second cited study: it is powerful stuff. Sure there are limitations to the study design. The men were asked to recall events that happened 30 to 60 years prior; that can be tough for even a sharp as a tack Nobel prize winner so there may be some recall bias here. Rules for tackling when these men were young were very different than they are today; direct head contact was likely more common then. But still this is data that should not be dismissed as sensationalist or over-reaching.
We have certainly seen that other sports such as hockey and soccer now recommend minimum age ranges for full body checking (hockey) and heading (soccer) due to the fact that they felt the data available required them to do so. USA Football has definitely taken positive steps with their Heads Up Tackling and Heads Up Blocking programs but currently the age at which tackle football is allowed is 5. It’s time to have a closer look at this. My opinion on this issue is as it is with all other health and safety issues for young athletes: a safer sport has a much better chance of keeping kids in the game for life.