Brody Silva is a typical 10-year-old boy: bright-eyed, curious, and restless. He wrestles; he runs track and cross-country; and he plays baseball, basketball, and football, which is the center of his life. He loves the Dallas Cowboys, worships All-Pro cornerback Richard Sherman, and figures he, too, might go pro one day. But he also has aspirations beyond the game. When he retires from football, he says, “I want to be a doctor or a brain surgeon.”
For now, he alternates between playing running back and linebacker for the Alaska Steelers, an 11-and-under “Mitey Mite” team coached by a husband-and-wife duo of Army veterans who often hold practice inside gyms to escape the frigid cold. Over Thanksgiving week last fall, as the Steelers took the field in warm Daytona Beach, Florida, Silva was in the middle of every defensive play—”I get to truck people,” he gushes—even though some of his teammates were physically overmatched at the 2017 National Youth Football Championships.
Ryder Rego, a defensive lineman playing alongside Silva, was leveled three times while pursuing the ball, each time bringing about a stoppage in play. On the third such knockdown, Rego stayed down for what seemed like an eternity. Coaches and game officials stood over his body like cops at a crime scene, while players took a knee. “Your heart skips a beat, but then you see him get up,” says Lacey Rego, Ryder’s mom, who watched the scene unfold from the Steelers’ sideline. “I was super proud of him. He just kept moving forward and was there for his team.”
The 4'6", 80-pound third-grader wasn’t diagnosed with a concussion or removed from the game. After all, these weren’t NFL-caliber hits. These were just boys whose helmets made them look more like bobblehead dolls than warriors, and injuries have always been part of the game.
From the peewees to the pros, we’ve long accepted the toll that football exacts on the body—the sore muscles, the broken bones, the torn ligaments, the lost teeth, the risk of paralysis, and, especially in recent years, the dangers of concussions. The risks are worth it, the thinking goes, because the sport demands toughness and forges character. But recent research is painting an even grimmer picture of America’s Game and revealing how destructive football can be to children’s brains. If Silva indeed grows up to become a brain surgeon, he may look back on his childhood and wonder why he and his friends were ever allowed to play tackle football.
“We do everything possible to keep our kids healthy, to keep them free from injury, to help them realize their full potential,” says Robert Stern, Ph.D., a professor of neurology and neurosurgery at Boston University. “Then we drop them off in a field and put a big helmet on them and say, ‘Go hit your head as many times as you want and play hard.’ Regardless of where we are with the science, does it make sense to do that?”
Soft-spoken but exacting, the bearded and bespectacled Stern is the director of clinical research at BU’s CTE Center, where he studies the effects of repetitive brain trauma on athletes and military personnel. (CTE is shorthand for chronic traumatic encephalopathy, the neurodegenerative disease that has cast a black cloud over football since entering the national conversation in 1997.)
Because of the game’s violence, the 59-year-old calls himself a “former football fan.” He once flew to Arizona to see his beloved Patriots play in the Super Bowl, but now he avoids games on TV, sometimes at the expense of his social life when friends get together on Sundays. In 2016, he was named the seventh-most-important person in the NFL by USA Today, one of the “biggest game changers” even though he’s not part of the league. “It’s not because of my throwing arm,” he says. “It’s because of the potential impact of my research on the future of football.”
About 3 million boys play tackle football in America, according to the National Sporting Goods Association—that’s roughly 2,000 players for every NFL pro. About 40 percent of these kids fall between the ages of 7 and 11. Nine years ago, before the concussion crisis, the participation number was closer to 4 million. The drop-off has been largely attributed to fears over CTE from concussions, which Stern says is a legitimate concern but also the wrong thing to focus on. “It’s concussion this, concussion that,” he says in his paper-strewn office. “With the focus on concussions, it takes everyone in a different direction from what the real problem is.”
That would be “subconcussive” hits, the repeated blows to the head that occur on every play without knocking anyone out of the game. In some people, those repetitive hits can lead to changes in the brain’s structural integrity, Stern says, making CTE an important risk factor for players long before they ever get close to the NFL.
“With the focus on concussions, it takes everyone in a different direction from what the real problem is.”
The brain sits in the skull the way salmon is stored in a can. It’s protected, sure, but with sudden accelerations and decelerations, it jounces around inside and can be damaged. Your brain cells stretch, twist, and undergo chemical changes. After a single injury, the cells’ default response is to clean up toxic proteins and chemicals. But when the head is hit time and again, that recovery sequence becomes overwhelmed. One consequence is a buildup of tau, an abnormal protein that clumps together and creates tangles that eventually choke brain cells to death. It can also spread to other cells and propagate, leading to CTE.
Typically, CTE can only be diagnosed posthumously, but its symptoms in the living range from the temperamental (anxiety, depression) to the behavioral (aggression, lack of self-control) to the cognitive (poor memory and memory loss, confusion). CTE has been found in deceased players at every level of the game, from the pros down to high school. The longer you play, the worse the likely brain damage. “Around 3,000 hits,” says Julie Stamm, Ph.D., a former BU researcher and now an associate lecturer of kinesiology at the University of Wisconsin-Madison, “is the threshold where you start to see increased risk of having cognitive difficulties later in life.” For a player who starts tackle football at age 7, that threshold can be reached by age 18 if he averages 250 hits a season—a number that research shows can be easily doubled by some players.
A recent BU study, published in Brain, established the strongest link yet between repetitive hits to the head and CTE. It focused on a postmortem examination of four teenage football players who had suffered sports-related head injuries: One had already developed early-stage CTE, and two others had started producing the frayed tau protein. To test their hypothesis—that early CTE may result from damaged blood vessels within the brain—researchers subjected lab mice to a series of football-like repetitive head impacts. What they found is that they could induce CTE in the mice without putting them through the equivalent of a concussion.
Playing youth tackle football may be exposing kids’ brains to that same risk. A 2017 study coauthored by Stamm and Stern in Translational Psychiatry found that people who started playing tackle football before age 12 doubled their risk of having behavioral problems and cognitive impairment, and tripled their risk of suffering from depression later in life. The increased risks did not change based on how many years they had played, the number of concussions they had, or whether they played through high school, college, or the pros.
The findings were in lockstep with a growing body of evidence that shows youth football may be doing more harm than good. A 2015 study led by BU’s CTE Center ran 42 former NFL players (ages 40 to 69) through a battery of cognitive tests and divided them into two groups: those who started playing football before age 12 and those who started later. Why 12? “Because of the neurodevelopmental literature showing there’s a lot happening in the brain around that age,” Stamm says.
Between the ages of 8 and 12, the brain works overtime to make myelin, a coating that grows around, and protects, fragile brain-cell connections called axons. The heaviest construction occurs in the branchlike pathways that connect the right frontal lobe of the brain to the left frontal lobe. Ultimately, the study found that the pre-12 group performed “significantly worse”; their tests revealed evidence of “executive dysfunction, memory impairment, and lower estimated verbal IQ.”
A young child’s head-to-body-size ratio is roughly four times larger than that of an adult. And that, combined with a child’s thinner, weaker neck, means impacts cause more rapid head movements. All of this seems to put kids who play tackle football well behind kids who don’t, from a developmental standpoint. (Your brain doesn’t fully mature until your early 20s.) Another BU study found that cognitive, behavioral, and mood problems may affect former football players an average of 13 years earlier if they played before age 12. But, Stern warns, “there’s no right age. It’s not like 12 is magic. It’s not like starting at 14 makes it safe.”
A recent Wake Forest study revealed exactly how young brains are being rewired by the game. Researchers followed a group of 25 boys ages 8 through 13 over a season of tackle football and placed sensors inside their helmets to measure impacts. (A typical hit registers between 20 and 25g—the equivalent of a 30 mph car crash—and players can pile up anywhere from 250 to 580 crashes a season.) The MRIs of the kids’ brains taken before and after the season showed that those “who experienced more cumulative head impact exposure had more changes in brain white matter.” The stunning part: Not one had suffered a concussion.
“Just the routine hits changed the brain,” Stern says. “That’s what parents need to hear.”
Football is already facing a reckoning. Lawmakers in New York, New Jersey, Maryland, Illinois, and California recently proposed legislation that would prohibit tackling in their states below the ages of 12, 13, and 14. In Pittsburgh, a father’s attempt to prevent the youngest of his three sons from playing, spurred by the latest scientific research, became the focus of a family court dispute.
Last season, the NFL’s TV ratings fell 9.7 percent; the year before that, the decline was 8 percent. The league’s thrilling championship between the Philadelphia Eagles and New England Patriots drew the smallest Super Bowl TV audience in the past nine years (103.4 million viewers). Just before the title game kicked off, a Wall Street Journal/NBC News poll revealed that interest in watching the pro game among close followers had dropped 9 percent since 2014. Beyond viewing habits, the risk of traumatic brain injuries was a concern at home; 53 percent of mothers polled said they would steer their kids away from playing football “due to concerns about concussions”—a 13 percent spike over 2014 poll data.
But not everyone is swayed by the emerging science. Last November, at the youth-football championships in Florida, it was hard to find an adult who expressed a deep understanding of the game’s health risks to the brain. Nearly all of the parents interviewed by Men’s Health said they trusted coaches to teach proper hitting techniques, believing good form takes the head out of the game. Concussion awareness was a concern, many said, but they overwhelmingly believed USA Football when it said that its Heads Up program had reduced practice injuries by 76 percent and concussions by about 30 percent. (A 2016 New York Times investigation revealed that those claims, which had been used in online marketing campaigns and congressional testimony, were overblown and misleading.)
“You can’t convince me anywhere—anywhere—that these kids are hitting each other to that degree, improperly, to where they’re getting CTE when they’re older in life,” says Leonard Rhein, the coach of a 12- and 13-year-old team from Illinois whose 10- and 12-year-old sons have played football since they were 6. “Attacking [football] at the 12-and-under level is wrong and it’s unfounded. CTE is a real thing, there’s no question, but that’s at the highest level when you basically have two freight trains running into each other.”
Anita Smith’s son, Jacobi Eatman, is a tight end and defensive lineman on Rhein’s team. He started playing football at age 5 but was pulled out by his mom at age 9 because of her concerns about concussions. When Jacobi turned 11, he was allowed to play again because Anita felt he “was bigger and could understand the game more.” But she still has her reservations.
“Every time he takes that field, I have to ask myself, ‘Am I doing the right thing?’” she says. “Ultimately, the love that he has for the game, the camaraderie, the teamwork, the unity—all that has allowed me to allow him to do what he loves. And I do know that it comes at a risk. I pray every time he takes that field that I never have to be one of those parents who has to realize that fear.”
Vanessa Silva, whose son Brody wants to be a brain surgeon, says it would be hard to take him out of football because of his “deep love for the game . . . it would devastate him to not play.” But she might do it once he suffers his first concussion. “I do actually know parents that don’t have their kids play because of that specific reason,” she says. “What it boils down to, honestly, is we’re just risking that chance.”
Attempts are being made to make football safer. The NFL instituted a stricter concussion protocol in 2009 and players will be subject to ejection this season if they initiate contact with their helmets, Pop Warner has limited the amount of tackling in practices since 2012, and the Ivy League has banned tackling during regular-season practices since 2016. But no helmet can make it a safe game by preventing concussions or sub-concussive hits.
“When folks say that football has never been safer, on a continuum, I don’t deny that,” says Carol Sente, the state rep who sponsored the Illinois bill to ban tackling for 12-and-under players. “But to me, it’s like putting a longer filter on a cigarette. The public-safety issue is significant.”
America's pediatricians seem out of the loop. In the 1950s, the American Academy of Pediatrics drew a line in the sand between its patients and contact sports, including football and boxing. It said they “have no place in programs for children” 12 and younger. In the 1960s, though, the AAP’s stance softened. It made exceptions for the majority of contact sports. (Stay away “unless a school or community can provide exemplary supervision.”) And hockey was given the green light in 2000. (Okay, as long as body checking is “limited” for players 15 and under.) But those advisories read like stiff rejections compared with the change of heart the AAP expressed in its 2015 policy statement on the full-contact aspects of youth football.
While it acknowledged that eliminating tackling would reduce injuries, concussions especially, it nonetheless recognized “that the removal of tackling from football would lead to a fundamental change in the way the game is played. Participants in football must decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling.”
It appears America’s pediatricians, who swore an oath to do no harm to children, are punting. “We really feel strongly that there’s a lot of data out there that says a sedentary lifestyle is much more risky to your long-term health than the risk is for injury while you’re playing a sport or doing an activity,” says Cynthia LaBella, M.D., AAP’s Council on Sports and Fitness chairwoman. “We don’t have any longitudinal studies, unfortunately, that follow these kids 30 or 40 years down the road.”
Stern, for one, is beyond mystified by the AAP’s position. “Is there a medical reason why it would be good for someone to play tackle football? There couldn’t possibly be one,” he says. “If kids are obese or have poor self-esteem, they need to exercise, and there are plenty of other activities or team sports . . . but there’s absolutely nothing that could make it good for kids to hit their heads over and over again.”
A longitudinal study is a fine idea and, yes, it could deepen our understanding of youth football’s true dangers. But it’s also time-consuming, expensive, and logistically ponderous. More to the point: Longitudinal studies weren’t the only catalysts that shifted public opinion on lead exposure (which is bad) or smoking (which is worse) or seat belts (which are now the rule of the road). Eventually, enough evidence was enough evidence for common sense to start changing public opinion.
In a 2017 study published in The Journal of the American Medical Association, Stern’s colleague Ann McKee, M.D., a Boston University neuropathologist and the world’s preeminent expert on CTE, analyzed the donated brains of 202 players from all levels and found CTE in a whopping 88 percent of them. And while CTE at the high school level (21 percent) was far lower than at the college level (91 percent) or in the pros (99 percent), a one-in-five chance of brain damage at the high school level still means 10 potential heads a season on a typical 50-man JV/varsity squad.
“I used to think it was a numbers game,” Dr. McKee says of all the damaged brains that have come through her lab, “and that if we have enough, people would pay attention. But I actually don’t know what tips the scales for people who don’t want to acknowledge that football is dangerous. There’s something to the play of football that damages the brain. That, to me, is irrefutable.”
A version of this article appeared in the July/August 2018 issue of Men's Health Magazine.
