The mind-numbing risk of America’s pastime

When I mention America’s pastime, I’m not talking about baseball. If you still think baseball is America’s pastime, you’re revealing yourself as a Boomer or member of the Greatest Generation. According to Gallup Poll results on most loved sports, 1972 marks the point at which baseball fell to number two. News flash: football is far and away the most popular sport in the U.S.

Football at all levels, from the NFL down to middle school, is wildly popular in this country. Cultural historians invoke warfare analogies to explain why football resonates with America more than genteel sports like baseball, graceful ones like soccer, or artistic ones like basketball. For the sake of brevity and in an effort to amble towards the premise of this post, I will give water polo and ice dancing a bye in my characterization of popular athletic endeavors.

Football may be popular. But football leads to concussions. Note: I did not say football can lead to concussions. I did not say it sometimes causes them. It would be disingenuous to use a conditional verb between football and concussion. Head injuries are inevitable in this sport. They are part of the process. They are intrinsic to the activity. However, finally and fortunately, this reality is becoming harder to deny and the long-term sequelae of concussions is growing harder to dismiss.

The biological consequences of concussion continue to be revealed as the problem is more studied. A recent article in JAMA Neurology (March 2, 2015) adds to the literature indicating that concussion leads to decreased cerebral blood flow that can persist as long as a month, or longer, and that problems with cognition, depression, and anxiety correlate with this reduced blood flow.

Why blunt head trauma leads to reduced blood flow is still unclear. For the brain to experience less blood flow during a period when it probably needs more, to recover from damage, sounds like a recipe for problems.

What are we as physicians to do with this information? We can graphically advise our young patients and their parents of the risks. Young people’s participation in tackle football increased by 21% in the first decade of this century. I think we should bluntly tell our young patients and their parents that they should not participate in tackle football. It is not safe. It cannot be made safe with better helmets or cosmetic rules changes. Of course every sport has its potential risks. I am not downplaying the risks of serious knee injuries in basketball or shoulder injuries in baseball, among others. And there are serious health risks from not participating in sports, most notably obesity. The difference with football is the brain is a vital organ; the shoulder and knee are not. The brain’s capacity for repair is limited; orthopedic surgeons can work miracles on damaged joints.

Football may be more glamorous than tennis or long-distance running. But its risks are much more serious. We as physicians can probably not influence the mass culture of support for football. But we have a duty to sway our young patients away from participation.

Richard Fleming, MD

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