The Future of Football

June 8, 2018  • Institute Staff

Sports & Society’s Tom Farrey Talks to four experts about the dangers – and merits – of the all-American sport.

In January, the Institute’s Sports & Society Program looked at one of the most fraught issues in sports: the dangers of football. With mounting evidence about the nature and extent of brain trauma in football players, the sport is at a crossroads. Tom Farrey, the executive director of the Sports & Society Program, spoke to Dr. Robert Cantu, the co-founder of the CTE Center at the Boston University School of Medicine and a senior advisor to the NFL’s Head, Neck, and Spine Committee; Domonique Foxworth, a former NFL cornerback, the ex-NFL Players Association president, and the author of The Undefeated; Scott Hallenbeck, the executive director of USA Football; and Jennifer Brown Lerner, the policy manager of the Institute’s National Commission on Social, Emotional, and Academic Development. Each has wrestled with the realities of tackle football—as a caregiver, a participant, a promoter, and a parent.

FARREY: Should kids play tackle football before high school? A recent headline in The Dallas Morning News asked: “Is Football Over? Why Studies on CTE is Bad News for the Game.” It’s a reference to a Boston University study on repetitive head contact and chronic traumatic encephalopathy. We’ve seen research on how retired NFL players who played football before age 12 performed significantly worse on verbal IQ, executive function, and memory tests. The Concussion Legacy Foundation even began a campaign to make flag football the only football that can be played before age 14. We’ve also seen laws introduced to ban tackle football before the age of 12. We work with the Sports and Fitness Industry Association and know that, among 6-to-12-year-olds in 2009, 1.5 million children played football; now it’s fewer than one million.

Among 13-to-17-year-olds in 2009, it was 2.4 million; now it’s 1.9 million. Meanwhile, NFL ratings are down by about 10 percent; 1.6 million fewer people are watching regular season games than in the prior year. This is a real pipeline issue, because we know from ESPN research that kids who play a sport are three times more likely to become avid fans of that sport. One positive sign is that flag football is up among 6-to-12-year-olds. It has gone from 788,000 to 893,000 in one year. So, is flag the future? What if flag and not tackle was the standard way of playing football until high school? How much does the parent control the future of football?

HALLENBECK: Absolute gatekeeper. Parents want information more than ever, they want the research, they want it synthesized so they can understand it. They need more choices. It’s one of the reasons we have looked closely at the American Development Model, which many sports are adopting. ADM is the idea of giving more entry points for parents. Frankly, football’s behind the times; it basically only has flag and tackle options. So, we’re evolving. We’re looking at five-on-five flag. Do we explore the idea of nine-on-nine flag, where you actually can introduce linemen? You might even introduce a little bit of blocking and defeating blocks; you might introduce some contact. It can be a progression, or it can be individual entry points; parents can decide. Because without a positive experience, it’s game over.

CANTU: For over 50 years, we’ve been diagnosing and managing concussions. In 2007 and 2008, we started to accumulate athletes’ brains, and our experience with CTE grew. Multiple papers we’ve been a part of have shown, if you play tackle football under the age of 12, you have a higher chance later in life to have cognitive behavioral and mood problems—and a greater chance to have brain atrophy—than if you started playing at a later age. This is paralleled in boxing and other sports, too.

Then, over the last several years, the elephant in the room reared its head: dose response. It’s like pack years and smoking cigarettes. Who is at highest risk for CTE? It’s the person who took the brain trauma over the greatest number of years and had the greatest number of total hits to the brain—the highest dose response. And if that’s not enough, our group came up with an animal model that shows causation of CTE from repetitive brain hits in the absence of concussion. So a concussive hit counts more than a sub-concussive blow, but sub-concussive blows alone can cause CTE. About 20 percent of CTE cases don’t have recognized concussions during their lifetimes.

I want more people to play football. I just want youngsters at the highest risk not to get their head hit 200 times over the course of an average season. You couldn’t do that to your child and get away with it, and yet they can do it to themselves on athletic fields. I want very much for football to be played in a safer form: flag. But it’s the parents who are driving the bus.

FOXWORTH: I’m not in favor of abolishing football. I also don’t want to come across as radical—but I don’t know that we need football. Talking about making it safer is important, but it’s still a progression that leads to a proven dangerous experience for the kids. We need to reconcile that, and we need to be honest about that. No matter what age we set—you can’t do tackle football until you are 14—well, then when you are 14, you’re exposing yourself to a number of sub-concussive hits. So, I just want to make sure that no one leaves here thinking, if we move to flag before age 14, we’ve solved the problem.

I loved football when I was a kid, and I believe that football is a unique sport. It saddens me that my son isn’t going to be able to experience that, but I am certainly not going to willingly put him in that situation. Part of the problem is that it’s essentially an arms race. Coaches care about winning and that’s fine, but they also believe that whoever can practice more and practice harder is going to be better. That’s true for 6-year-olds all the way up to the NFL. That’s why some of things that we implemented in the NFL in the last collective-bargaining negotiations are restrictions: your practices can only be for a certain amount of time, you can’t have two a day, you can only have 14 padded practices throughout the course of the season.

LERNER: Flag is the only option for my kids from kindergarten through eighth grade. That’s what we’ve decided. The bigger question for parents is, Are you comfortable with your child playing tackle football beginning in high school? I struggle with what the research is telling us. I’m thrilled that I have a K–8 flag option for my kid to play football. I’m going to think long and hard about what happens after that. I’m not sure for my own child that it’s going to be tackle. I hope we can move flag all the way up. I know people play in college, and maybe it’s not competitive enough for folks, but I hope that’s the model we move toward.

Football is uniquely American, and I want my kids to be able to understand the game, to be able to play in some form. My family has a pickup game over the holidays. I don’t want my kids to be like, “What’s a first down?” That’s almost un-American.