By Bart Pfankutch – South Dakota News Watch

Edited by Shereen Sewert – Wausau Pilot and Review

Tackle football remains one of the most popular sports in America, but participation in high school football in Wisconsin and across the United States is falling steadily as the risk of brain injuries from the sport becomes clearer.

Participation in 11-player boys football in Wisconsin dropped 4.4 percent in the last year alone and by 22.7 percent over the past decade, according to data from the National Federation of State High School Associations, which has published annual participation surveys for more than 25 years. Numbers in neighboring states are similar; participation in South Dakota fell by 5.2 percent over the past three years, the data show.

Participation in nine-player football, played in smaller, mostly rural districts, fell by 3.7% across the nation over the past 10 years, according to the survey.

Nationally, total participation in athletics fell across all sports for the first time in nearly 30 years; participation in boys 11-player high school football — the sport with the highest participation among all sports — fell by 5.2% last year to about 1.1 million players.

Recent studies have shown that from 5 percent to 10 percent of youth football players will suffer a concussion — defined as a “mild traumatic brain injury” — at some point during a full season. With about 1 million athletes playing high school football in the U.S. annually, that means between 50,000 and 100,000 teens will suffer a concussion each year, not including those at the youth and junior high levels.

Supporters of football — including players, parents, coaches and association officials — see the sport as one that builds character, focuses on teamwork and is outright fun to play and watch. They also note that fear of injury is only one element of a complex decision that high school athletes make in terms of whether to play football or any sport.

Furthermore, population trends have shown reduced enrollment in many rural schools and decreased opportunities for play.

“I think it’s more than just looking at the number and saying, ‘Well, over this period of time we’re down all these kids participating and that it’s because we’re concerned about safety,’” said John Krogstrand, assistant director of the South Dakota High School Activities Association, who oversees boys sports for the group. “I think it’s much more than that.”

Krogstrand noted that his association and all school districts across the state have implemented new safety guidelines, improved equipment and instituted concussion protocols to prevent head injuries and treat them better when they do occur. He also said some of the drop in participation is likely due to a drop-off of high school enrollment in the early 2000s, which led some schools to end their programs.

He noted as well that much of the enrollment growth in the state has been in Sioux Falls and its suburbs, where opportunities to play are limited to one team at each school no matter how big the school gets.

But with mounting evidence of significant long-term impacts of football-related injuries, particularly those to the head and brain, the survey data reveal that parents and young players themselves are increasingly staying away from the sport.

In Wisconsin, the reduction in participation has led some districts, including many in rural areas, to keep the sport alive by entering into co-op agreements in which nearby schools combine players to form a single team. Other schools that have seen enrollment and participation decreases have moved from 11-player to nine-player football, which makes it easier to field a team.

Most parents whose children play football are aware of the risks, yet many say they believe the game has gotten safer as the awareness of concussions and other head injuries has risen.

Dale Uttecht of Sioux Falls, shown here at a recent high school football game in Rapid City, has two sons who play football. Uttecht said that while he sometimes worries about the potential for injury, he believes the sport is generally safe and leaves the decision of whether his sons play the game up to them. Photo: Bart Pfankuch, South Dakota News Watch

Dale Uttecht of Sioux Falls traveled to Rapid City on a recent Friday night to watch his son, Joe, play football for Sioux Falls Washington against Rapid City Stevens. As he bought four cups of hot chocolate on a rainy September night, Uttecht said he sometimes holds his breath while watching games played by Joe or his older brother Logan, who plays wide receiver for Augustana University.

“All the players are bigger, faster and stronger, so any injuries are going to be worse,” he said.

Uttecht said the increased recognition of the risks of head injuries in football has led to changes that he believes have made the game safer, including at Washington High, where a certified trainer is present for all practices and games.

“You always have concerns, but I hear about concussions in soccer and basketball, too,” Uttecht said. “It’s really their decision if they want to play to not.”

Strong link between concussions and football
Numerous research studies have shown a strong correlation between concussions and contact sports, particularly football. A concussion is a mild traumatic brain injury in which the head and brain shake violently, often causing confusion, headaches, dizziness, nausea or vomiting, and in severe cases, loss of consciousness. Most people who suffer a concussion recover fully with time, and research is inconclusive whether a single concussion will lead to long-term brain impairment. Evidence shows, however, that the longer a person plays football and the more hits to the head they take, the chance for long-range impairment or illnesses increases.

American football at the youth, high school, collegiate and professional levels has been the most-analyzed sport in relation to concussions.

The federal Centers for Disease Control and Prevention estimates that between 1.6 and 3.8 million concussions occur annually in the U.S. owing to sports and recreational activities, though many more likely go unreported and untreated.

Recent research has shown that football, hockey and rugby are the sports most likely to lead to concussions, and that 9.6 percent of all injuries in youth football are concussions, 4 percent of injuries in high school football are concussions and 8 percent of collegiate football injuries are concussions.

In their literature on concussions and sports, doctors at the Sanford Health Orthopedics & Sports Medicine Department in Sioux Falls write that, “One of the worst things any athlete can do for their health is to keep playing after a concussion.”

Yet those same physicians report that as many as 40 percent of youth athletes who suffer a concussion return to play sooner than safety guidelines suggest. They also point to research showing that athletes who suffer one concussion are more likely to have subsequent concussions and can face “potentially catastrophic consequences” if a second concussion occurs.

Children and teens are more susceptible to concussions and take longer to recover than adults, the Sanford doctors said.

Research has increasingly shown a link between concussions and other brain injuries to long-term play of tackle football. In part due to concerns over player safety, participation in high school football has fallen in South Dakota, though the game remains immensely popular for many players and fans. Photo: Bart Pfankuch, South Dakota News Watch

Thayne Munce, associate director of the Sanford Sports Science Institute, is an expert on brain injuries related to football and has led research efforts into on-field head injuries, specifically at the middle-school level.

Munce used sensors in the helmets of seventh and eighth grade football players to measure the number and severity of hits to the head during games. Generally, his research showed that players in those grades received fewer head impacts than high school players, mainly due to fewer practices and games being held. But he also found that the severity of head impacts in the lower grades was equal to those suffered at the high school level.

“Their head-impact severity, basically what happens to a head after an impact, is nearly identical to high school level,” Munce said. “Even though they’re smaller athletes and not running as fast, their impact severity is just as high.”

Munce pointed out that significant research does not seem to show that athletes who only play through high school will have long-range brain injuries or neurological implications.

“There isn’t enough strong evidence that suggests playing youth football or through the high school level has a significant risk of long-term negative brain health consequence,” Munce said.

In a larger sense, Munce said research into football-related brain injuries is advancing rapidly, but he noted that in many ways scientists “are flying blind” when it comes to fully understanding the risks associated with the sport and its impact on the brain and long-term brain function.

A growing concern for athletes in contact sports, particularly football, is the finding that chronic traumatic encephalopathy, or CTE, has been diagnosed in people who have had repeated jolts or hits to the head, including but not limited to repeated concussions.

CTE has no treatment or cure and can lead to mood disorders, memory loss, behavior problems and dramatic personality changes. In CTE, a destructive protein spreads through the brain, killing brain cells along the way.

Some recent CTE research and individual cases have raised concerns over the potential for brain damage in football players. CTE can only be diagnosed in the brain by autopsy following death.

The results of a 2017 study by researchers at Boston University and reported in the Journal of the American Medical Association showed that CTE was found in the brains of 177 of 202 former football players, including 99% of those who played professionally and had been in the game the longest.

Study conclusions were limited, however, because of “selection bias” since the donated brains tended to come from patients who exhibited symptoms of cognition or behavioral problems before death.

New research at BU in 2018 further heightened concerns about repeated brain injuries and the connection to a condition called Lewy body disease, which can increase the risk of dementia, Parkinson’s disease and Alzheimer’s disease. The study showed that participants in contact sports including football, hockey and boxing were more likely to develop Lewy body disease, even independently of symptoms of CTE.

CTE risks drew national attention after Aaron Hernandez, a college and professional football star, committed suicide in 2017 while incarcerated on multiple murder convictions at the age of 27. Doctors later said his brain showed the worst case of CTE they had ever seen in someone so young.

The NFL has made concussion identification and prevention a top priority over the past few years, expanding examinations and increasing the list of symptoms that can prevent a player from returning to a game.

Yet Brett Favre, a retired quarterback now in the NFL Hall of Fame, has said he would not encourage his own children to play the game he loves so deeply. (Favre has said that, luckily, he has only daughters.)

The Wisconsin Interscholastic Athletic Association has links to information about concussions on its website under a “Health” heading, including the advice, “When in doubt, sit them out.”

WIAA officials say school districts across the state have been aggressive in improving safety for football players and improving protocols to address injuries when they do occur.

In a 2019 ranking of high school safety policies by the Korey Stringer Institute, Wisconsin ranked ninth-best among the 50 states.

Editor’s note: This story is being republished through a partnership in the Institute for Nonprofit News Amplify program. Read the original story, which focused on South Dakota, here.