The hard hits, high impacts, and constant poundings make football, football.  This fast paced sport has been one of the most popular in the country for the past decades.  However, due to these hard hits, impacts, and fast pace, football is also one of the most dangerous sports played.  From a young age, football players are subjected to countless hits at practice and at games.  At the professional level, these hits keep piling up and upon retirement a player has endured these hits since they were playing peewee football.  A serious concern in today's game is the rapid increase in concussions and the developments of more serious, life-threatening brain diseases.  This problem has always existed in football, however it has become an increasingly debated topic with the large amount of CTE diagnoses and deaths. This serious issue brings to light another question; should we let our kids play this dangerous sport and be susceptible to permanent brain issues?  There are multiple opinions regarding this question and an answer exists somewhere in a combination of all of them. For this argument, I am honing in on youth and high school football specifically, while using facts and information from NFL and other football programs to explain my thinking.  I think that for parents to let their kids play football, there needs to be significant changes in the areas of concussion education, advanced equipment, and informed personnel.   

In sports today, concussions are often overlooked and seen as more of a hassle than an issue.  While in reality a concussion is a serious injury that takes several weeks for it to fully recover.  The American Association of Neurological Surgeons defines a concussion as "an injury to the brain that results in temporary loss of normal brain function.  It usually is caused by a blow to the head.  In many cases, there are no external signs of head trauma (The American)." There are countless symptoms of concussions, however they differ from victim to victim.  Mark Halstead and Kevin Walter, authors of a clinical report titled "Sport-Related Concussions in Children and Adolescents", say that "the signs and symptoms of concussion fall into 4 categories: physical, cognitive, emotional, and sleep" (Halstead).  Some symptoms include headaches, nausea, vomiting, impaired balance, visual problems, photosensitivity, phonosensitivity, fatigue, and cognitive problems such as slowed reaction time and memory deficits (Mukand).  It is important for us to be knowledgeable of all of these symptoms to be able to identify and treat concussions in the early stages.  Being able to recognize any of these possible ailments could potentially save a person's brain from any permanent damage. Halstead and Walter note that "the athlete should be evaluated for retrograde (before the event) and anterograde (after the event) amnesia by asking questions about details of events before and after the injury ... Mental fogginess may be a good predictor of a slower recovery from concussion in athletes" (Halstead).  Mukand later goes on to discuss the differences of concussions in children versus adults.  He says, "Due to the more complex recovery process in young athletes, they need protection when they are most vulnerable.  Recurrent concussions are especially destructive to the brain and are more likely during the first ten days after a concussion or if the athlete has had a previous concussion" (Mukand).  This is an important fact to comprehend, as it asks us to take a harder look at how we handle concussions at the youth football level versus how we handle them at the professional level. 

A debatable issue in football today is whether or not CTE, or Chronic Traumatic Encephalopathy, and football have a direct correlation.  According to the Boston University CTE Center, "CTE is a progressive degenerative disease of the brain found in athletes with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head ... this trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau" (What Is).  Dr. Bennet Omalu, the chief medical examiner of San Joaquin County, Calif. and an associate clinical professor of pathology at the University of California Davis, was the first person to diagnose CTE in 2002.  Omalu authored an article titled "Don't Let Kids Play Football", in which he lays out his thinking and why he feels that it is too dangerous for children to be subjected to the hard impacts in football. He says "If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms" (Omalu).  Omalu believes that if he were able to study football players' brains during and after the season he could obtain significant knowledge on how this sport is affecting the brain.  He also believes with the right amount of research a possible remedy could be created to stop, prevent, or remove CTE from damaging the brains of these athletes.  Omalu is an advocate for safer games, and his number one priority is safety of the youth football players.  He claims that there is a link between CTE and football and wants to explore deeper into the topic to help save football players from possible lifelong injuries.  There is opposition to this thinking that CTE and football are linked and one such person is NFL doctor Joseph Maroon.  Maroon claims "I think the problem of CTE although real is its being over-exaggerated and its being extrapolated to youth football and to high school football" (Florio).  Dr. Matt McCarthy also has this same mentality, as he states "At the 4th International Conference on Concussion in Sport. . .world experts gathered to discuss the state of head-trauma science. At the end of the conference, a consensus statement was released that said the following: 'A cause and effect relationship has not as yet been demonstrated between CTE and concussions or exposure to contact sports'" (Florio).  These claims are contradicting to those of Boston University and Omalu, and they provide valid counterarguments.  While there is no concrete link between CTE and football, there is data to show that there is a strong background to make the claim that CTE is caused by football.  "In a study released in October, 87 of 91 former NFL players who donated their brains to science tested positive for the disease" (Gutierrez) and "Omalu has estimated that more than 90 percent of all NFL players have CTE.  The disease, however, can only be diagnosed after death" (Gutierrez).  Taking both of these sides into careful consideration, I still believe that CTE can be linked to football and that changes need to be made to help these players have a healthy life after football.

A recent study found that there are about 182,000 football players that sustain a concussion a year and it branches out to about 99,000 in youth football, 79640 in high school football, and 3905 in NCAA football.  These numbers can be averaged out to say that about 1 in 30 youth players and 1 in 14 high school players suffer a concussion each year (Mukand).  These statistics are eye-opening, as they help to clarify how frequently a child playing football gets hurt.  With this information, it is important that a concrete, successful plan of action is in place so that these concussions can be spotted, treated, and healed as quickly as possible.  Janie Cournoyer and Brady Tripp conducted an experiment to see how educated high school football players are about concussions.  Cournoyer says "adolescent athletes' lack of knowledge about concussions may be one of the main predictors of a premature return to play after sustaining a concussion.  Evidence also suggests that young athletes, parents, and coaches do not have the knowledge needed to assess and manage concussions and make return-to-play decisions" (Cournoyer). This is a strong stance by Cournoyer and she is moving towards the idea that something needs to change to prevent these young athletes from permanent brain damage. Cournoyer and Tripp surveyed 334 football players from 11 different high schools throughout the state of Florida. Their study asked these athletes to name possible symptoms of a concussion, possible consequences of an improperly managed concussion, and if the athlete had been educated about concussions.  The results of this survey were truly astonishing.  Cournoyer and Tripp stated "we believe that the lack of knowledge about concussions was the result of a lack of quality of education on this topic" (Cournoyer).  In other words, this survey shows how these athletes are susceptible to serious injury because they do not possess adequate knowledge about concussions.  This claim that lack of education was the catalyst for the lack of knowledge also provides branches for the other possible results of this survey. Due to a lack of education, athletes may be unaware of some not so obvious symptoms and consequences of an untreated or multiple concussions.  There are a few stipulations to this survey, as it was a relatively small sample size and it was only in the state of Florida. Also while Cournoyer and Tripp label education as a key in helping to lower concussions, they do not point out other flaws in the current system.  Some could point to their focus on education, but giving no definite solution to this issue.  However, this survey does lay the groundwork that there are flaws in the current high school football system and a deeper look needs to be taken. 

Recognition is the first step in treating a concussion.  If a concussion is spotted in the earlier stages, there is less of a chance for further implications to develop.  After a blow to the head, the athlete should be checked immediately for any possible symptoms of a concussion.  Halstead and Walter say "Initial sideline evaluation should include an inquiry into the athlete's symptoms, a neurologic examination, and evaluation of the athlete's cognition by using one of several available sideline assessment tools" (Halstead).  What Halstead and Walter are saying is that after a possible head injury is obtained, the athlete should undergo rigorous tests to determine the severity of the injury.  To complete this, there must be a trained professional on the sideline of each game.  Josh Hunsucker, author of "Buckle Your Chinstrap: Why Youth, High School, and College Football Should Adopt the NFL's Concussion Management Policies and Procedures", offers his insight on how to make the game safer at the youth levels.  Hunsucker suggests implementing changes the NFL recently made to recognize and stop concussions.  Hunsucker lists the new NFL policies, "In 2012, the NFL focused on increasing concussion awareness by ensuring teams, players, and officials received more education on the signs and symptoms of concussions. It also updated the NFL sideline Concussion Assessment Protocol and removed players from the field immediately upon suspicion of a concussion, as opposed to after diagnosis" (Hunsucker).  This is only two examples of rule changes the NFL made, but these are specifically two that could easily be implemented into youth and high school football systems across the country.  As stated before, educating all parties, officials, coaches, parents, and players, is the first step in a bigger process of stopping concussions.  With this education, concussions can be spotted and the athlete can be immediately removed from the game or anymore possible harm.  Officials could recognize a symptom in a player, stop the game, and get this athlete the proper treatment so they can heal and return to football sooner than they would if they had played the rest of the game with a concussion.  The second part of the quote above talks about immediate removal from the field of play after suspicion of a concussion, not diagnosis.  This rule change is all about safety, and does not leave anything up to chance.  This rule could prevent an athlete from falsely passing a concussion test and returning to the field of play.  Hunsucker also writes "significantly, the league implemented a policy of adding independent certified athletic trainers to a press box area equipped with video replay access and communications to each team's medical staff to monitor for potential concussions missed by teams on the field of play" (Hunsucker).  This is an important rule change that can pay huge dividends for athletes.  This athletic trainer is fully qualified and knowledgeable on concussions, and is watching every play looking for something out of the ordinary.  This trainer has direct communication with the medical staffs and can notify them of any possible concussions.  Professional athletic trainers would be harder to add to youth and high school football for a few reasons, including cost and lack of video replay.  While youth and high school may not be able to adopt this exact policy, they could implement a similar version.  There could be a licensed athletic trainer that works for both teams, hired by the district for all teams.  This trainer could focus on the game and if any hard hits to the head occur, that player could be taken out of the game to run through precautionary tests.  Lawrence Robbins, author of "Stop Football. . .Save Brains: A Point Counterpoint Discussion", offers ideas on how to lower the amount of concussions in football.  This article also possesses a counter argument from Dr. Frank Conidi.  One idea Dr. Robbins suggests is removing hitting until the age of 18.  Dr. Conidi provides a counterpoint saying, "If you ban hitting before the age of 18, you are in essence placing an individual who has had little to no strength training and skill training to protect himself with full grown men.  In my opinion, that approach places the athlete at greater risk for concussion and even traumatic brain injury" (Robbins).  Conidi also refutes the idea of a better helmet by saying, "Some have suggested improved helmet technology. Helmets, however, do little to prevent concussions (mouth guards do nothing) and way too much money is being spent attempting to "dumb down" the evaluation of concussion is to immobilize the neck and that opens a whole new can of worms" (Robbins).  Dr. Conidi provides good insight, however I still would side with Dr. Robbins as concussions are a part of the game and all measures should be taken to ensure that it is as safe as possible for future generations.  

Children are susceptible to brutal hits that can leave their brains scrambled and concussed.  Concussions come in different forms and can induce many possible symptoms.  All concussions are different; therefore, each one should be treated individually.  Concussions that do not get proper treatment can cause deadly head diseases such as CTE.  These diseases have arisen in a staggering amount of retired football players, and even in some that did not even play at the professional level.  At this moment, I feel that youth and high school football are too dangerous and provide too great of an injury risk to allow these kids to continue playing.  There are numerous changes that can and must be implemented.  Educating coaches, players, officials, and parents on concussions could help to prevent a child from receiving multiple concussions without treatment.  A qualified athletic trainer should be stationed on the sidelines of all games, allowing for them to treat and diagnose a concussion immediately.  This will help the child combat the concussion at the onset, allowing for a greater chance of no after effects.  Even with these changes football remains a dangerous sport.  I would argue that without these changes and more, parents should refuse to let their children play football.  

