NFHS Voice: No HS Football Link to CTE

October 21, 2019

By Karissa Niehoff
NFHS Executive Director

When it comes to the long-term effects of concussions in sports, there is a wide range of information published – almost on a daily basis. Unfortunately, much of the media coverage as it relates to high school sports – and particularly the sport of football – is misleading.

Last week, the Concussion Legacy Foundation introduced its new public-service announcement that compared youth football dangers to smoking. As the pre-teen football players puff on cigarettes, the voiceover says, “Tackle football is like smoking, the younger I start, the longer I’m exposed to danger.”

The “Tackle Can Wait” campaign by the foundation is an attempt to steer children under the age of 14 into flag football. Although establishing a finite age may be difficult, reducing contact at youth levels is certainly a positive. USA Football is doing just that nationally through its Football Development Model. Likewise, the 51 member state associations of the National Federation of State High School Associations (NFHS) have enacted limitations on contact during preseason and practice sessions.

Our concern is the term “exposed to danger.” These types of messages continue to spread unwarranted fear to parents of high school student-athletes. The “danger” refers to reports that players who incur repeated concussions can develop chronic traumatic encephalopathy (CTE).

A 2017 study from the Journal of American Medical Association (JAMA) linked CTE in the brains of deceased National Football League players. Even if this report is accurate, these are individuals who endured repeated blows to the head for 20 to 25 years BEFORE any concussion protocols were in place.

Less publicized is a study by Dr. Munro Cullum and his colleagues at the Peter O’Donnell Jr. Brain Institute, which is a part of the University of Texas Southwestern Medical Center in Dallas. Cullum’s group studied 35 former NFL players age 50 and older who had sustained multiple concussions throughout their careers. The findings showed no significant association between the length of the individuals’ careers, the number of concussions and their cognitive function later in life.

Two studies, two different conclusions. Regardless of the outcome, however, they are not applicable to kids playing football before and during high school. There is absolutely no linkage to CTE at these levels, and the word “danger” should not be a part of the discussion.

A more applicable and significant study was also published in JAMA in 2017. In a study of about 4,000 men who graduated from Wisconsin high schools in 1957, there was no difference in cognitive function or decline between those who played football and those who did not as they reached 65 years of age. We would assume the majority of these individuals discontinued football after high school.

With more than one million boys – and girls – playing the contact sport of football each year, severe injuries do occur from time to time, but parents should know that efforts to lessen the risk of a catastrophic injury, including head injuries, have never been stronger than they are today.  

In fact, new data from the National High School Sports-Related Injury Surveillance Study indicates some positive trends in concussion rates. The study, which was released in the American Academy of Pediatrics online issue of Pediatrics last week, indicated that concussion rates during football practices dropped from 5.47 to 4.44 concussions per 10,000 athletic exposures between the 2013-14 and 2017-18 seasons.

In addition, repeat concussion rates across all sports declined from 0.47 to 0.28 per 10,000 exposures during the same time period.

Concussion laws are in place in every state. All NFHS sports rules books have concussion management protocols. Helmet-to-helmet hits are not allowed in football. Limits on contact in preseason and practice in football are in place in every state.

After considering all the available research, we encourage parents to let their kids play their sport of choice in high school, but we would discourage moving away from football – or any contact sport – solely based on the fear of developing CTE later in life.

Dr. Karissa L. Niehoff is in her second year as executive director of the National Federation of State High School Associations (NFHS) in Indianapolis, Indiana. She is the first female to head the national leadership organization for high school athletics and performing arts activities and the sixth full-time executive director of the NFHS, which celebrated its 100th year of service during the 2018-19 school year. She previously was executive director of the Connecticut Association of Schools-Connecticut Interscholastic Athletic Conference for seven years.

Involvement vs. Meaningful Involvement

November 27, 2012

By Jed Blanton
MSU Institute for the Study of Youth Sports

As I've worked with the MHSAA in student leadership development and through my role in performance consulting and mental training, a number of coaches and athletes have asked me how to “get kids to buy in” or see the vision of their coach/captain, etc.

Particularly in high school sports, rosters consist of players with reasons for participating in their sport that range from pure enjoyment and social life, all the way to kids with aspirations and ability to play in the highest level of college athletics.

Having a range of talent, and then a range of desire and commitment can be a difficult load to balance as a coach.

Based on the questions I've been posed over the years, it seems that the magic answer lies somewhere in this notion of “buy-in” and if, just if, the coach could trigger that “buy-in” everything would work out. A winning season or at least a more successful season would be a certainty, and all the athletes would be emotionally involved, or more so, emotionally invested, as well as completely and fully physically and mentally committed to THE GAME.

This almost sounds like the ideal ending of a Disney sports movie … but that doesn't mean it isn't a possibility, and we can find some ways to make your reality closer to this vision.

The trick is … there is no trick; there is no magic formula. The ability to create “buy-in” means giving up something that might make a coach shudder and cringe just a bit. My challenge to coaches is this: Give up control. SHARE some of the duties and tasks you feel are your job, with … your players.

DON’T hit the back button or close your browser just yet. Let me explain.

The first thing to understand here is how people learn. If we want our athletes to “buy in,” we may have to teach “buy-in” first, which involves understanding how people learn behaviors and adopt a mentality, as the state of “buy-in” would be considered.

Psychologically, we know that people can learn merely from watching and modeling others. But in the short-term, this tends to include only behaviors, not the more abstract notions of passion or commitment which is seemingly what coaches desire more of in their players when we talk about “buy-in.”

However, it is important. So the first thing a coach needs to do is behave in such ways that indicate they are “bought in,” more so than just telling kids to be more committed. Have you ever stopped to think about what it looks like when someone has “bought in” to an athletic team’s vision? Do you have a team vision statement to guide behaviors and goals?

The next step in how people learn new behaviors upon watching others is having those behaviors they are attempting to mimic reinforced. Encouraging players and showing gratitude to those who demonstrate the desired mentality will help foster the expectations you have for your players. I must point out here that punishing or dismissing players and behaviors that stray from this desired state won’t help the learning process.

Next, and here is where the challenge lies, is sacrificing some control and sharing some responsibilities with your players. This entails involving them in the process of the sport. So often our high school athletes experience sport very passively. They are told what to do, how to do it, and when to do it. Then critiqued, sometimes put down and constantly judged on their abilities to do very little else than act in the ways they are told to act.

There is no option for personal investment here. Trust is the guiding factor. And while trust is extremely important, it’s not what may ultimately create “buy-in.”

Involvement fosters ownership. Meaningful involvement requires an emotional investment because the amount of responsibility increases. So what does being meaningfully involved look like? Being meaningfully involved in the sport as an athlete would mean being able to make decisions that are then actually carried out before they are critiqued. If you ask a player what they think about any given decision, then tell them what you think (which is also what they’ll do), you are merely seeking input rather than allowing them to be involved. What would it look like if the captain or senior players were able to set the starting line-up or batting order? Or what if the athletes were in charge of running a two-hour practice once a week? How about letting one or two of the athletes decide what play is going to be run in the final minutes of a close game? I mentioned the word “trust” earlier, and the key in these examples is coaches are showing athletes “trust.” This just might be what fosters the all important “buy-in.”

The hardest part on the coaches’ end is letting the decision play out, and then talking about why it may have failed. Discussing it rationally, debriefing the decision, and allowing them to process where the mistake was made without placing blame on them is where athletes can really learn about their sport, their role on the team, and how to make tough decisions while sharing in the full experience of the competition and preparation. 

There is always a chance they’ll make the same decision you would make as the coach. After all, they have been practicing in your system. This is a great way to assess if you are having an impact and if your athletes are learning rather than just passively participating. 

As a former athlete, I can honestly say I never truly understood my sport (distance running) until I was asked to serve as a race director or create training programs for younger athletes and people interested in taking their running to a more competitive level. I’m sure for most first-time coaches, the number of decisions you have to make humbles your former-athlete self rather quickly.

Watching the student leadership program participants I work with struggle with projects and presentations they are asked to design is tough, and I want nothing more than to help them and make sure that it’s “right.” But I can also say that in those times when I've been able to see the end result in those instances when they made the decisions, they created something on their own, they are happier, more knowledgeable, and certainly “bought in,” as they have control for the first time. 

Blanton is a doctoral candidate at Michigan State University in the department of Kinesiology, specializing in the PsychoSocial Aspects of Sport and Physical Activity, and a research assistant for MSU's Institute for the Study of Youth Sports. He has served as a facilitator at MHSAA Captains Clinics the last three years and currently is assisting the association with its student leadership programs.