Can We Make Football Safer?

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Changing the stigma around and frequency of injury in football requires a collaborative, educational effort involving all stakeholders.
Changing the stigma around and frequency of injury in football requires a collaborative, educational effort involving all stakeholders.

The topic of safety in football has dominated the conversation around the sport over the last few years. The recent admission of a relationship between playing football in the NFL and chronic traumatic encephalopathy (CTE) by an NFL executive has only fueled the debate around the long-term consequences of the full contact sport.

With what we know now, is it possible to make football safer?

Yes, I believe it is possible to make football — and other sports with a high risk of brain injury — safer, but the answer does not lie within a single solution.

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When it comes to football, I believe that we shouldn't throw the baby out with the bathwater, as they say. Yes, there is a very apparent risk of both acute and chronic neurological impairment associated with participation that recent research indicates may be mediated by age, sex, level of participation, and other modifying factors, but there are benefits as well. Health and fitness, lessons in teamwork, overcoming adversity, time management, mental and physical toughness, and the benefits of accomplishing a shared goal through competition are commonly cited examples. I would add academic, social, and even survival-related benefits, particularly among participants from underserved communities, to that list. In some areas, the school dropout rate differs dramatically between those who play football and those who don't. How do we quantify that kind of risk compared to the risk of concussion? After all, the risk/benefit analysis is different for every person and every environment.

Interestingly, most of the lay public believe that equipment, including new and improved helmets, mouthpieces, sensors, and more have the most potential for improving safety. However, given the anatomy and mechanisms associated with brain injury, it is clear that only incremental benefits are possible through pursuit of better equipment. While manufacturers may describe a reduction in forces associated with certain products, or tout the ability to monitor impact forces, there is no convincing data that indicate these pieces of equipment or information are significantly related to reduction in clinical concussion risk or sub-concussive injury. Scientists and the sports medicine community tend to focus on neurophysiologic and imaging breakthroughs, biomarkers, best practice/protocols, or identification of genetic and other modifying factors that might significantly affect individual risk to improve safety.

There is no shortage of data either, with millions of dollars dedicated to ongoing research. Overall, both groups of pursuits have varying degrees of promise and potential, but it will take time to objectively vet benefits. So what can we do in the meantime? How can we reduce the risk of head injury in football and make it safer right now while science, technology, and knowledge evolves?

Education Is the Difference

There is no silver bullet. Reducing brain injury and improving safety in football requires a multi-faceted approach. I believe in the overarching goal of education. But the approach to education should be very specifically related to that which emphasizes effective knowledge transfer resulting in change in behavior.

Multiple well-designed research surveys (or a brief period of channel surfing on a Sunday during football season) reinforce the fact that players, coaches, and other stakeholders are aware of the risks associated with practice and competition, but very few have changed their behavior or approach to the game. Coaches tend to coach certain ways, and players tend to play with a gladiator mentality. More than 10 years of “education” has raised awareness of the safety issue, but has done very little to change behavior. If education is to result in effective knowledge transfer that makes football safer, both the message and the messenger are critical.

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