For as long as I can remember, I have loved sports. In fact, I struggle to find an accurate way to articulate how meaningful sports have been to me. Basketball, baseball and football, my sports of choice throughout childhood, taught me many valuable life lessons I would have otherwise missed. Despite my general passion for all sports, football holds a special place in my life. I am enamored with everything about it: watching it, discussing it, scheming for it and playing it. The relationships I have built and the lessons I have learned through my football experiences are unmatched by those of any other sport I have played.
I started playing organized tackle football in fourth grade, but my love of the game started much earlier. My first football memory was going down to the basement to play catch with my parents with a Donald Duck foam football. Soon thereafter I was outside playing catch with a youth football, and then, I was off to the playground at recess. My passion for throwing the ball continued to grow, and I have now been playing quarterback for the last 11 years, with two more years left to play at St. Olaf College. Though I have outgrown Donald Duck and tackles are no longer made by accidentally colliding with opposing players, the pure joy I associate with football has not changed.
While the physical demands of football are obvious, the cognitive challenges of the game are equally as intense. There are complex schemes, play options and other strategic decisions that must be made within split seconds. As a quarterback, I find the cognitive challenges of reading the defense and calling for the right option or checking the routes exciting yet complicated, especially with 21 other players who are rapidly racing across the field. I feel that the team aspect allows players to hone in on and exercise leadership skills to help coordinate the action on the field and motivate the group. It also provides a strong social support to athletes and creates a sense of belonging to a mutually caring organization. We are a brotherhood.
I decided to attend St. Olaf College in hopes of becoming a physician, not an NFL athlete, so I understand the importance of maintaining a healthy brain. It is actually quite crucial for succeeding in school and doing well on the upcoming MCAT, but I have yet to consider quitting football simply because of a possible injury. I have experienced so many positive benefits from football that I could not imagine life without it. In addition to developing amazing relationships within the team, we have had the opportunity to work with Special Olympics by participating with those athletes in combined sporting events. We have also partnered with Team Impact, giving us the opportunity to add a five-year-old with a chronic illness to our team. The relationship our team has made with Team Impact and the player’s family would not be possible without football. The St. Olaf football team has also provided me with many leadership opportunities. I am a member of the team’s Leadership Council that works as a liaison between players and coaches and a co-president of the Student Athletic Advisory Board, a student-led group that works with the college’s athletic director to better the experience of student-athletes on campus. Again, I would not be able to participate in any of these amazing opportunities without football.
Disconcertingly, concussion is a diagnosis now commonly associated with football, thus fewer voices advocate for continued play of the sport. While repeated concussions in professional athletes have been shown to lead to motor symptoms and contribute to cognitive decline, as demonstrated in early studies in boxers describing “punch drunk syndrome”(1), {Gonzales, 1951 #491}the applicability of these findings to youth team sports is unclear. The physical, mental and social benefits to youth gained from playing football; along with soccer, lacrosse, bicycling and other activities associated with concussion, are well described(2) and not inconsequential.
The media has helped football have a reputation as a “dangerous sport.”. However, almost all sports have some risk. Annually, approximately 7.9 percent of injuries in college football are ultimately diagnosed as concussions(3) compared to 9.2 percent of injuries in women’s college soccer (4). Furthermore, sports such as equestrian, bicycling, skiing/snowboarding and skateboarding all have annual rates of death which are higher than that of football players (5).
A study was done assessing the long-term neurologic disease incidences of former football players versus members of the chorus, glee club or band. It suggested that high school football players from between 1946 and 1956 were not at an increased risk for dementia, Parkinson’s disease or amyotrophic lateral sclerosis (ALS) more than 50 years later (6). There is concern that the repetitive mild traumatic brain injury, or concussions, sustained by players during contact leads to the development of Chronic Traumatic Encephalopathy (CTE)(7); while some go further to suggest that even a single concussion can lead to CTE (8). The incidence of CTE has recently been found to be the same in normal healthy-aged people as in people with neurodegenerative disease, raising questions regarding the clinical significance of finding CTE on pathologic examination (9).
Despite the findings that concussions may lead to an increased risk of suicide (12), this does not appear to outweigh the suicide risk reduction associated with playing sports. The 2014 suicide rate for American males was 20.7 per 100,000; yet NFL athletes have a rate of 12.5 per 100,000 since 2005 (13). When adjusted for income, the NFL players are still at lower risk than the general male population (14). Students who play organized sports and partake in other athletic activities are found to have lower suicide rates than non-athletes (15). Recent findings from Rai, et. al, found that suicide rates for men and women from age 18-22 was 11.6 per 100,000 but dropped to 7.5 per 100,000 among those who attend college. Participating in college athletics drops the suicide rate even more dramatically to 0.93 per 100,000. When assessed as a separate group, college football players had a suicide rate of 2.25 per 100,000, remaining significantly lower than the national average for college students who are non-athletes (16). Ironically and sadly, physicians stand out as one of the highest risk groups with a suicide rate of more than two times the general population at a rate of 28-40 per 100,000 (17).
Participation in sports also correlates with decreased findings of clinical depression. A study by Babiss et. al, suggested that adolescents (seventh to 12th grade) are less likely to suffer from depression or suicidal ideations if they participate in sports. The study illustrated that with increased athletic activity, there is a decrease in depression symptoms by 25 percent. It additionally showed that suicidal ideation decreases by 12 percent with an increase in sports participation (18). These findings suggest that while contact sports do have risks associated with them, perhaps the psychological benefits gained with participation are greater than those physical risks.
There are some groups who are pushing to ban youth contact sports(10), while others(11) are leading the charge to “play smarter.” For many participants, football is the game of choice based on their size, physicality and desire, which do not match well with other sports. Without this sporting option, more children may develop sedentary lifestyles (5). This may lead to more harmful lifetime consequences, including a greater risk for diabetes, heart disease, obesity, high blood pressure and dementia, any of which are ultimately a worse alternative.
After reading numerous reports about the dangers of football, I will admit that I have thought more about the risks of playing the sport. From youth leagues, to middle school, to high school varsity and now college, I have witnessed and experienced the increase in both the physical demands of the sport and the hard-hitting collisions. However, as the demands and collisions become greater, coaches ensure appropriate training both in the weight room and on the field to prevent injuries. In addition, the equipment continues to improve. With the emergence of better technology and information, the advances in equipment and player technique have evolved in an attempt to keep players safer.
Recent reports that highlight the dangers of football and other contact sports are contributing to decreased participation in youth athletics. The argument to have kids participate in other sports is not easily adapted, as the child who excels at football may not do as well in other less “dangerous” sports. Additionally, risks of concussion are even permeating into non-contact sports, as described earlier. The decrease of youth athletes participating in sports has led to an increase in health problems, such as obesity and heart disease, as well as factoring into an increase in youth suicide and depression. The positive social and physical benefits of an active lifestyle in conjunction with team play are likely to lead to healthier development and eventually a healthier adult lifestyle.
The complex psychosocial benefits of football are implied by the results of a survey performed in our research lab by Vikalpa Dammavalam. She asked 155 brain injury experts, 103 of which were neurosurgery department chairs, about their prior sports participation. Of the 65 responses (51 neurosurgeons), 22 played football in high school and eight played football in college, making football the most commonly played sport among neurosurgical department chairs who answered the survey.
I hope to one day be able to combine my love for football and medicine and work as a team doctor. I currently have a strong interest in both neurosurgery and emergency medicine, both of which I find to be very well-suited for working with sports. This summer, I worked in the Brain Injury Research Lab of Uzma Samadani, MD, PhD, FAANS, at Hennepin County Medical Center (HCMC) as a Rockswold Scholar, a program through St. Olaf made possible by neurosurgeon and longtime brain injury researcher Gaylan Rockswold, MD.
In the lab, we are working on trying to better understand and objectively classify brain injuries by using blood-based biomarkers and eye tracking metrics. Through my time at HCMC, I have worked extensively in the Emergency Department attempting to recruit patients for our ongoing studies. With this work, I have witnessed firsthand numerous patients coming into the hospital who have suffered different forms of trauma. The number and nature of injuries I have seen from sports does not come anywhere near the injuries from car accidents, bike accidents or even people tripping and falling. This has reassured me that the benefits of sports do in fact outweigh the risks.
Acknowledgments: I would like to thank Molly Hubbard, MD, and Dr. Samadani for their guidance and mentorship on this project and throughout my time at HCMC.
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References
1. Gonzales, T.A. (1951). Fatal injuries in competitive sports. Journal of the American Medical Association, 146(16), 1506-1511.
3. Football Injuries. In: NCAA, editor. https://wwwncaaorg/sites/default/files/NCAA_Football_Injury_WEBpdf. www.NCAA.org: NCAA; 2010.
4. Women’s Soccer Injures. https://wwwncaaorg/sites/default/files/NCAA_W_Soccer_Injuries_WEBpdf. www.NCCA.org: NCAA; 2010.
5. Black, D.M., & Rosen, C.J. (2016), Physicians and Youth Tackle Football.
10. Staropoli, N. (2015). Concussion Doc Calls for Ban On Youth Football. American Council on Science and Health.
11. Heads Up Football www.USAfootball.com: USA Football. Available from: https://usafootball.com/headsup.
