Dexter Coakley played in the National Football League for a decade, establishing a reputation as one of the best outside linebackers on the planet.

A three-time Pro Bowl pick with the Dallas Cowboys, football gave Coakley a life he could have never imagined growing up in his blue-collar neighborhood on Egypt Road in Mount Pleasant. A college education. National fame and recognition. Enough money to last a lifetime.

Despite everything that football has provided Coakley and his family over the years, he isn’t sure he wants his 7-year-old son, Zahn, following in his footsteps.

Coakley is among a growing number of parents reluctant to let their children participate in youth football because of safety concerns.

More than 2,000 former NFL players claiming they were never warned about the long-term effects of concussions have become the topic of discussion around football at all levels.

It has become such a hot-button issue that Pop Warner, the nation’s largest and oldest youth football organization with more than 300,000 participants in 44 states, issued guidelines this summer to limit contact during practices for the first time in its history.

“Zahn is not going to play tackle football until the seventh or eighth grade,” said Coakley, who lives in Dallas.

“I think he’ll learn more about the game playing flag football, learn the fundamentals of the game better, and then we’ll introduce him to tackle football. He won’t have the wear and tear on his body like most kids his age and he’ll definitely have more skill.”

Roddy White, an All-Pro wide receiver for the Atlanta Falcons from James Island, has a different view. His 6-year-old son, Sharod White Jr., is playing tackle football for the first time this fall.

“My son loves the game, he wants to play all the time, so why would I take that away from him?” White said. “I don’t want him to stop the learning the game by not playing it the way it’s supposed to be played. You learn the fundamentals of the game when you’re young, not when you’re in high school.”

And therein lies the dilemma for youth football, not only in the Lowcountry but also across the nation.

Football is far and away the most popular sport in the United States. With more and more headlines about catastrophic injuries in football and fewer and fewer parents willing to let their children play the game as a result of concussions and other serious injuries, what is the future of the sport?

Increased concussion risk

Dr. R. Morgan Stuart, a neurosurgeon at Roper St. Francis and the director of the hospital’s concussion program, said parents’ fears about head injuries in youth football are justified.

“Kids under the age of 14 are at an increased risk of sustaining concussions and having concussion-like symptoms than the adult population,” Stuart said.

Stuart said children are more at risk because their brains are still developing, their neck strength is relatively undeveloped and their heads are proportionately larger in relation to their body.

“These three factors kind of conspire against kids under 14,” Stuart said. “What we’ve seen from the research is that neck strength plays a very important role when it comes to concussions, and a child’s neck strength hasn’t developed like that of an adults.”

Research also shows that repeated blows to the head will have long-term effects.

Study after study has concluded that athletes who are subjected to repeated blows to the head will develop Chronic Traumatic Encephalopathy.

Researchers in Boston have studied the brains of deceased professional football players and found that many suffered from CTE. As blows to the head add up over a career, the basic structure of the brain is altered by a buildup of proteins.

The results can be catastrophic. CTE can lead to advanced forms of dementia and Alzheimer’s disease. Former NFL players who died in their 40s and 50s showed advanced degrees of dementia and Alzheimer’s.

“I think the evidence is pretty conclusive,” Stuart said. “A broken ankle can heal. You can come back from a knee injury. But something like CTE is permanent.”

Practice, practice, practice

There are about 5 million people playing organized football at all levels — youth leagues to the pros — in the United States, according to a study conducted at Wake Forest and Virginia Tech universities.

Their research shows that youth football has fewer head injuries and concussions than college and high school players. Most head injuries that did occur in youth football came during practice.

The NFL and many college football teams already have reduced the number of full-contact practices. The South Carolina High School League has limited the number of two-a-day practices teams can have during the preseason in hopes of reducing injuries.

None of the Lowcountry’s youth football leagues are affiliated with Pop Warner, and none have adopted that organizations’s guidelines on contact during practice.

But local recreation departments have taken steps to reduce the risk of injuries.

In Summerville, the Sertoma youth football league does not allow contact for the first four days of practice, and has limited contact in the next four practices.

“This is something we’ve had in place for a few years,” said Calvin Linning, executive director of the Summerville league. “We wanted to be ahead of the curve on this issue. We think that gives the kids a chance to ease into the season and reduces the chance of them getting hurt.”

In Mount Pleasant and Moncks Corner, the recreation departments offer coaches clinics on how to detect concussions and what to do about them.

“We had doctors and trainers in from Trident Medical (Center) and they did a pretty thorough presentation on concussions,” said Moncks Corner recreation director Tim Atkins. “I think it was very helpful for all the coaches.”

A football family

Mike Shaw is on the sideline yeling out instructions to young players on a cool, late summer night at the Park West recreation facility in Mount Pleasant.

Shaw, 48, stands in front of his offensive linemen while an assistant coach gets into a three-point stance and demonstrates the proper way to block.

“Keep your head up, hit with your pads, and use your legs to drive,” Shaw said.

Shaw’s 10-year-old son, Ian, is playing in Mount Pleasant’s mite football league for kids 10 and 11 years old. He’s a fullback and defensive lineman for the Patriots, the team his father is coaching. This is Ian’s fourth year of playing organized football.

Ian’s mother, Rebecca, wasn’t thrilled when her son decided to play football.

“It seems like every time you pick up a newspaper or watch television, there’s a story about a college player or a professional player that is getting seriously injured,” she said.

“These guys are supposed to know what they’re doing. As a mother that scares you. I try not to go overboard with my worries, but I’m mother, so it’s difficult. Having Mike out there does give me some level of comfort because I know that there’s someone looking out for Ian.”

Mike Shaw, a Southern California native, played football through high school. He said the only concussions he suffered as a kid came while he was surfing.

“Sure, there’s some concern there,” Shaw said. “There’s always a possibility of a child getting hurt, but that can happen anywhere.”

Shaw said he started the season by teaching his players the proper blocking and tackling techniques. Forty years ago, when Shaw was still playing, he was taught to lead with his head when he was tackling.

“We didn’t spear guys back then, but we were definitely taught to hit with our heads,” Shaw said. “We try to teach the kids not to lower their heads and hit with their helmets but hit with their bodies. That’s the best way to help reduce the risk of sustaining a head injury.”

Modern-day equipment

Football players today are bigger, stronger and faster. Their football helmets, which have evolved from leather to the current polycarbonate, are supposed to be safer.

That might not be the case.

The old “leatherhead” helmets that were used more than a century ago offered as much or more protection from severe head injuries than modern-day helmets, according to research conducted by the Cleveland Clinic, a nonprofit academic medical facility in Ohio.

Researchers conducted impact tests, crashing helmets together at severities on par with 95 percent of on-field collisions in collegiate and high school football games. For this study, researchers analyzed hits that are common in games and practices.

“The point of this study is not to advocate for a return to leather helmets, but rather to test the notion that modern helmets must be more protective than older helmets simply because ‘newer must be better,’ ” said lead researcher Adam Bartsch, director of the Spine Research Lab in Cleveland Clinic’s Center for Spine Health.

“Unlike cars, in which seat belts, airbags and crumple zones make the choice between a 1920s Model T and modern mini-van a no-brainer, these results tell us that modern helmets have ample room to improve safety against many typical, game-like hits.”

The Cleveland researchers found helmet safety standards are based solely on the risk of severe skull fractures and catastrophic brain injury, and not concussion risk. So while modern helmets may prevent severe head injuries, this study found that they frequently did not provide superior protection in typical on-field impacts when compared to leather helmets.

“Today’s safety standards are no longer state-of-the-art predictors of injury,” said Edward Benzel, chairman of the Cleveland Clinic’s Department of Neurological Surgery.

“Of course, preventing skull fractures is vitally important, but concussion prevention needs to be an integral part of the standards as well. Also, helmets need to protect against the cumulative effects of multiple lower impact blows that may not lead to a concussion immediately but may add up to cause severe long-term head, neck or brain injuries.”

The study didn’t surprise Stuart.

“NASA hasn’t developed a helmet that can protect an individual from a direct hit from a 300-pound lineman,” Stuart said. “When a player that big hits you, it feels like a freight train, and there’s almost no protection for that. Collisions like that are an inherent part of the game.”

Football on decline?

The emphasis on head injuries has at least one sports sociologist predicting that football will become a niche sport like the mixed martial arts — a violent spectacle with limited audience appeal.

“Football is really on the verge of a turning point,” Jay Coakley, a professor at the University of Colorado at Colorado Springs, told The New York Times. “We may see it in 15 years pretty much the same place as boxing and ultimate fighting.”

But the popularity of the sport and its massive crowds are hard to ignore.

Last Sunday night’s Pittsburgh-Denver game drew more than 30 million viewers. It was the most watched regular-season NFL game in almost two decades.

College football is a multibillon-dollar business with unprecedented television contracts.

Football isn’t going anywhere, Dexter Coakley said.

“Football is still king, especially in the South,” he said. “This has been a football nation for the last 30 years, and I don’t see that changing.”

The numbers of participants in area youth football leagues is about the same as last year. In Summerville, 687 kids are playing football this season, which is almost identical to the number they had in 2011.

In Moncks Corner there are nine teams and 205 players, which is also similar to last year’s totals. Mount Pleasant has one of the largest youth programs in the tri-county area with 872 football players.

While that figure is down from a high of a little more than 1,000 in 2007, Mount Pleasant Recreation Department Director Ken Ayoub believes that population trends are the reason, not safety concerns.

“There might be a few parents that don’t want their child to play football, but we’ve noticed that the town is just getting older,” Ayoub said. “It might be a combination of factors, but injuries have always been a concern for parents when it comes to football.”

The suicide deaths of former professional stars Junior Seau and Dave Duerson and last weekend’s neck injury to Tulane’s Devon Walker have only added to football’s image problem.

But is football being singled out?

The Center for Disease Control and Prevention compiled data from an eight-year study (2001-09) of head injuries that resulted in emergency-room visits for children in kindergarten through high school. Only injuries that involved recreational activities were included.

The No. 1 source of concussions was bicycling. Football ranked second.

“There are going to be collisions out on the field, and there’s not a whole lot we can do about it,” Ayoub said. “You’re not going to eliminate concussions and head injuries from football, but I do think football has become the focus of some unfair criticism.”

A decision for each family

Dexter Coakley believes that flag football is a legitimate alternative for children until they reach middle-school age.

“I know I wasn’t ready at that age to start tackling,” Coakley said. “We used to do these one-on-one tackling drills and it was all about the big hit. Technique and fundamental tackling was never a part of what we were taught.”

Stuart, who played soccer growing up, said he will not allow his son Leo, all of 3 months old, to play football when he gets older.

“I just think it’s too dangerous,” Stuart said. “I’m not suggesting that’s my recommendation for the general population, but I don’t want him to play.”

It’s been less than a month since the start of football season, but Stuart is already busy treating patients for concussions.

“We’ve had about a dozen concussion cases already since the start of the season,” Stuart said. “They all were a result of playing football.”