Football: Heading for trouble?

1. Knockin' heads

2. A player is down!

3. Caution about concussion

4. The macho factor

5. Odd sports injuries

University of Miami Hurricanes play West Virginia Mountaineers, Oct. 2, 2003. Photo: JC Ridley, University of Miami

Poster demonstrates the dangerous style of blocking with the head, from 1903.Graphic from: Popular Culture: from Baseball to Rock and Roll. Copyright: Prints and Photographs Division, Library of Congress(215).

Catastrophic injuries - to the brain, spinal cord, or skull - among high school football players from 1982 to 2002. "Direct" injuries are caused by the specific activities of the sport; "indirect" injuries happen when the body reacts to exertion or repetitive stress after the game is over. "Non-fatal" injuries cause permanent, severe disability; "serious" injuries are severe but not lasting. Data: National Center for Catastrophic Sport Injury Research

The bad old days: In 1968, 36 high-school and college football players died as a direct result of playing football, and 30 more were permanently disabled.

Football: organized warfare, or a triumph of common sense?
Football players go down after the ball.Playing football, rugby, lacrosse or hockey, to name a few especially violent sports, can damage your body and your mind. If you see him, just ask Atlanta Falcons quarterback Michael Vick about the physical toll of football. Vick is finally recovering from a leg he broke before the season even started.

But football is also tough on the brain and spinal cord.

Not too long ago, the sport exacted a grievous toll: In 1968, 36 high-school and college players died, and 30 more were permanently paralyzed. To get the true total, you'd have to add another 12 indirect deaths.

By 1976, the growing carnage caused high-school and college football authorities to ban tackling or blocking with the head. The "no-spearing" rule, together with the introduction of improved helmets in the late 1970s, led to a radical reduction in "catastrophic" injuries, those affecting the brain or spinal cord, including fractures of the skull or spine. Concussions, which we'll visit shortly, are in a separate category, because they heal by themselves.

poster shows 2 unhelmeted football players preparing to impact each other "The big reduction was after 1976, but now it's leveled off," says Frederick Mueller, who directs the National Center for Catastrophic Sport Injury Research, chairs the department of exercise and sport science at the University of North Carolina, and heads the American Football Coaches' Committee on Football Injuries.

Stats compiled by Mueller's center show that five high-school and college athletes died -- all from brain injuries -- in 2002 as a direct result of playing high-school or college football, which comes to 2.7 deaths per million players. Ten more football players died that year from "indirect causes," which are related to exercise, generally from heart attacks or heat stroke.

In other words, the death toll fell from 48 in 1968 to 15 in 2002.

Football is a rough sport, Mueller admits. While the "head-second" rule in blocking and tackling has saved lives, "Even if everyone is doing it correctly, headfirst impacts are difficult to avoid entirely." For one thing, players can get pushed out of position while trying to tackle shoulder-first and wind up hitting headfirst.

The drop in catastrophic injuries also reflects improvements in emergency care, Mueller adds. "I was watching a North Carolina game last weekend, and when a kid went down with a neck injury, the physicians and trainers were on the field for 20 minutes ... and didn't move him until he was on a back board. Twenty years ago, you'd never have seen that. He was lucky, had just strained his neck muscles, but they took the proper precautions."

Graph shows indirect and direct injuries.

Head not first
To get a picture of football injuries among younger kids, Michael Stuart, a professor of orthopedic surgery and co-director of the sports medicine center at the Mayo Clinic (Rochester, Minn.), studied 915 players in fourth through eighth grade for an entire football season. To establish a precise indicator of risk, each player's participation was recorded. The result, expressed as a risk of injury per play, was "actually quite low at this youth level," Stuart says.

Graph shows injuries increase with age.
2002: a Mayo Clinic study of youth football finds that while most injuries are mild, older players face much higher risk. Graph: Data from "Injuries Uncommon..."

Thirty-three players had the most common injury, a bruise. Although there was one concussion and four fractures involving the growth plate of the bone, no kids went to the hospital or had surgery, he adds. "I think the main conclusion was that the statistical risk of injury increases with the level of play. As players get older, they are likely to get bigger, stronger and faster." Per play, eighth-graders were four times as likely to be injured as fourth-graders.

Oddly, although older football players have gained greatly in size and speed, that has not shown up in injury statistics. "You would think so, but the numbers are just the opposite," says Mueller. "The high numbers [of injuries and deaths] came from a time when the kids were nothing like the size and speed they are today."

Is the concussion picture changing in football?

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