Should we ban kids under age 18 from playing football?

Note: I was asked on a recent radio interview if we should ban kids under the age of 18 from playing football, as proposed recently by Dr. Bennet Omalu. It is such a complicated issue, with medical concerns and all of the attention to concussions and CTE. There is also a legal side to the idea, including whether a child can legally consent to playing a dangerous sport. I thought that the issue would make for an interesting – if not controversial – topic for my latest newspaper column.Football sportsmanship

Should we ban kids under age 18 from playing football?

In a recent New York Times editorial, Dr. Bennet Omalu argues that kids shouldn’t play the
sport out of concerns 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 upcoming movie “Concussion” starring Will Smith.

The danger of trauma to the brains of young athletes

In his editorial, Omalu argues 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 these ages 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.

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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.

Critics weigh in on a ban of football for kids

Many people have criticized Omalu’s proposed ban, including Dr. Julian Bailes, chairman of neurosurgery at the NorthShore Neurological Institute and Brandon Marshall, wide receiver for the New York Jets.

ESPN’s medical analyst Dr. Mark 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 risk of repetitive blows to the head

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 onDoctor looking at brain MRI the ground and suffer a concussion, just like young football players suffer. But he is not going to slam his head against the ground hundreds 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.

The risk of CTE 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 these risks 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.

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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.

Parents must weigh the risks and benefits of football

Likewise, parents must evaluate the risks and benefits of football. Sports offer many benefits for our kids, including health improvements, Boy football player with helmet and mouthguardsocial interactions, 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 if the benefits of football are worth those risks.

What do you think about banning football for kids under the age of 18? What can we do to minimize the risk of brain injury in the sport? Please share your ideas below!

Note: This article appears as my sports medicine column in the December 23, 2015 issue of The Post and Courier.

References:

Don’t Let Kids Play Football. By Bennet Omalu. The New York Times. December 7, 2015.

Dr. Bennet Omalu: Wait until age 18 to play risky sports. ESPN.com. December 7, 2015.

Dr. Julian Bailes sees little risk of CTE from youth football. Pro Football Talk. NBC Sports. December 8, 2015.

Dear Dr. Bennet Omalu. By Brandon Marshall. Huffington Post. December 11, 2015.