The popularity of the National Football League has never been greater. NFL games comprised 34 of the 35 most-watched television shows last fall. More than 200 million Americans, or 70 percent of all television viewers, have watched at least one game this season.

At the same time, participation in youth football is beginning to decline.

Participation in the largest youth football program, Pop Warner, dropped 9.5 percent between 2010 and 2012, the largest decrease in the two decades the program has kept participation statistics. Similarly, USA Football reportedly saw a 6.7 percent decrease among players between the ages of 6 and 14 from 2010 to 2011.

Without question, the attention given to concussions and brain injuries to current and former NFL players seems to be taking a toll on parents. In an interview with League of Denial authors Steve Fairanu and Mark Fairanu-Wada for, Pop Warner’s chief medical officer, Dr. Julian Bailes, claims the concerns over head injuries is the “No. 1 cause” for the falling popularity of youth football. And a 2013 poll performed by Marist and HBO Real Sports showed that one-third of Americans are less likely to allow their children to play football due to concussion risks.

The NFL has launched a campaign to address these concerns through its youth development arm. USA Football implemented the Heads Up Football program in 2012. The campaign is funded entirely by the NFL and promoted by numerous former NFL players who serve as the program’s “ambassadors” to the 2,700-plus youth leagues which have adopted it.

The Heads Up program includes many initiatives aimed at improving the health of its young players. It promotes concussion awareness, educates and certifies coaches, teaches proper helmet fitting, and instructs players and coaches on heat illness and hydration. Most notably, it teaches a tackling technique that claims to remove the head from the play.

The Heads Up program’s tagline is “Creating a better, safer game.” Listen to or read some of the interviews of NFL coaches and former players, and you will hear those words used over and over.

Does the Heads Up program actually make football safer? No data currently exists to show that these techniques and education programs decrease head injury rates. USA Football claims that it is currently collecting data from 10 youth leagues — half of which utilize the Heads Up program — to determine its effectiveness.

USA Football and the NFL actively promote the program to parents. USA Football’s executive director, Scott Hallenbeck, acknowledged this education process on ESPN’s Outside The Lines. “We’re telling them that we are taking a logical, reasonable and proactive step to changing the technique and the terminology of how you teach tackling to ensure that the head is up and to the side.”

Critics of the Heads Up program claim that it is nothing more than a marketing ploy. As such, it is merely a public relations effort designed to convince parents that football can be made safe and therefore ensure a steady flow of athletes into the ever-popular NFL.

I think the components of the program are worth examining. Education about the dangers of concussions, certification of coaches at all levels and promoting tackling that avoids the use of the head are all worthy goals. After watching the instructional videos on the USA Football website, I do agree with some of the critics that the tackling technique promoted barely resembles the hits fans see on Sundays. Or Saturdays or Friday nights, for that matter.

Parents must understand that football is not, and likely will never be, completely safe. Even using this ideal tackling technique, a player can deliver a blow to an opponent’s shoulder and chest that causes his brain to slam into the skull in a whiplash-like manner. Better techniques might help, but it will likely take more radical changes to make a real dent in concussion rates. A current proposal to eliminate the three-point stance for lineman is a good example.

There is no question that we need more research to know if the Heads Up program can decrease the rates of concussions among young athletes. It seems fair to ask, though, if the NFL cares more about improving youth football participation rates.

I don’t really care if Heads Up Football is a marketing ploy or not. If it decreases concussions, it will be a success. If it doesn’t, and if concussions and their long-term consequences continue to escalate, no amount of marketing will help football.

Dr. David Geier is an orthopaedic surgeon and sports medicine specialist in Charleston. For more information about football injuries and other sports medicine topics, go to his blog at