Parents should consider proposal to ban children from playing football

Dr. Bennet Omalu (left), co-director of the Brain Injury Research Institute at West Virginia University, talks with Dr. Ira R. Casson, a neurologist and former co-chairman of the NFL Mild Traumatic Brain Injury Committee.

Should kids be banned from playing football?

In a recent New York Times editorial, Dr. Bennet Omalu argues that anyone under the age of 18 shouldn’t play the sport because of the risks of long-term brain injury. Omalu is the forensic pathologist who identified CTE in the brain of former Pittsburgh Steelers center Mike Webster. His discovery and the effort by members of the NFL’s Mild Traumatic Brain Injury committee to discredit his research is the subject of the movie “Concussion” that comes out Friday.

In his editorial, Omalu points out that society has chosen to ban a number of activities for children and adolescents — smoking, drinking alcohol, serving in the military and more. He cites the risk of trauma to the maturing brain before age 18. Banning football at this age would be similar to the calls by numerous medical organizations, including the American Academy of Pediatrics, to ban boxing for children.

There are two issues to consider about Omalu’s call to ban football before age 18. One is a medical concern — specifically the age at which the brain develops. Dr. Robert Cantu, Clinical Professor of Neurosurgery at the Boston University School of Medicine, fears for kids exposed to blows to the head under the age of 12. At these early ages, kids have disproportionately large heads and weak necks, creating a “bobblehead doll” effect. Each blow to the head creates a whiplash effect that shakes the brain against the skull.

This brain trauma can disrupt the circuitry between the brain lobes just as these centers are maturing. Damage at these ages could be irreversible. Cantu pointed to studies that show greater brain atrophy in boxers who started the sport before age 15.

Many people have criticized Omalu’s proposed ban, including ESPN’s medical analyst Dr. Mark Adickes. Adickes claimed football is no more dangerous than skateboarding, surfing or riding a bicycle. If we ban kids from playing football, he believes kids would engage in these supposedly more dangerous activities.

The flaw in that argument is the risk of brain trauma these activities present. Sure, a teenage boy could fall off his skateboard, hit his head on the ground and suffer a concussion, just like young football players suffer. But he is not going to slam his head against the ground dozens of times a day.

That is the real risk in football. I talked to Dr. Cantu, Dr. Robert Stern and Dr. Ann McKee of Boston’s Center for the Study of Traumatic Encephalopathy, where most of the brains of former NFL players have been analyzed and found to have CTE. They each insist that it is the repetitive subconcussive blows — the collisions between players that occur on every play — that appear to cause CTE in some players. Short of removing tackling and blocking from the sport, there is no way to eliminate those impacts in football.

It will be years before we know what percentage of football players will later develop CTE because we can’t currently detect it in living people. It could be decades before we can determine why some athletes seem to develop brain degeneration and others do not. By now, college and pro athletes know the risk of playing football and can make their own choices. Parents must decide if they want to keep dropping their young sons off at practice and allow them to withstand blows to the head over and over.

That decision leads me to my second point about Omalu’s call for a ban. Rather than comparing the decision to play football to alcohol or tobacco, consider kids suffering other football injuries.

Let’s say a 14-year-old linebacker dislocates his shoulder late in the season. Before surgery, the orthopedic surgeon describes the procedure’s risks and benefits. On one hand, surgery to reattach the labrum and tighten the capsule should stabilize the shoulder and allow him to return to sports. Surgery, though, does present small risks for complications like infection, nerve damage, recurrent dislocations, and medical and anesthesia problems.

Who signs the consent for surgery? Not the 14-year-old. Legally, mom or dad must weigh the risks and benefits and sign the surgical consent.

Likewise, parents must evaluate the risks and benefits of football. Sports offer many benefits for our kids, including health improvements, social interaction, leadership opportunities and much more. Football also presents possibly rare but real risks of later memory loss, critical thinking problems, mood disturbance and even suicide.

We need much more research to learn just how likely those risks are. Until we have those answers, parents will have to determine for themselves if the benefits of football are worth those risks.

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