You know what America's youngest football players really need? More opportunities to get hit in the head. All so they can learn the proper way to not get hit in the head. Or something like that. Such is the touted takeaway from an NFL-funded University of Pittsburgh study published last week, a study so flawed in its methodology and absurd in its conclusions that it would make for a great Onion article.
That is, if it wasn't completely real. And also potentially dangerous.
Here's the gist: Researchers at the school's medical center studied 468 football players ages 8-12 during the 2011 season. Between practices and games, the players logged more than 11,000 exposures; by the end of the season, 20 players had suffered "medically diagnosed" concussions, an injury rate similar to high school and college football. In addition, researchers found that the youth players were 26 times more likely to suffer concussions in games than in practice, leading the study's authors to conclude that: (a) organizations like Pop Warner that have reduced full-contact practice time in order to lessen brain risk are making a mistake; (b) full-contact practice for youth football players should be encouraged as a health and safety precaution.
"We actually feel that limiting practice time in youth football players could actually have deleterious or poor outcomes," said study co-author Michael "Micky" Collins, executive director of the university medical center's concussion program. "Because practice time is a time kids learn how to properly tackle. They learn the right technique. They can be educated about how not to use the head as a weapon. The proper way to tackle an opponent. The proper way to engage in football. We feel practice times are critical to teach kids the right way to tackle and play the game."
Before I get to Collins' dubious logic -- you know what will help alleviate our childhood diabetes epidemic? Kids practicing the right way to drink sugary soda! -- let's start with the study's data. It isn't particularly sound. Why? Because detecting and diagnosing concussions is difficult. Extremely difficult. Even during professional football games, where trained medical observers and tens of thousands of spectators are watching. Yet as the study's own authors note:
... with limited access to medical care during practices, concussion[s] in practice may have been underestimated ... It is also important to note that certified athletic trainers or physicians recorded the [game] concussion data for the studies depicted in Table II. In contrast, the concussion data from practices in the current study were not recorded in this manner, thereby potentially resulting in an underestimate of concussion in practices. (Bold added.)
Translation? The only people looking out for concussions at practices were coaches and/or parents. From a health and safety standpoint -- let alone a data collection standpoint -- that's simply not good enough. As brain trauma advocate and Sports Legacy Institute founder Chris Nowinski points out in Scientific American, studies have found that an athletic trainer's mere sideline presence increases the incidence of concussions four to eight times, while doctors can identify up to seven times as many concussions as trainers.
When I spoke to Chicago-area sports medicine expert Krystian Bigosinski last year, he sounded a similar note of statistical caution.
"A number of studies have compared the number of concussions athletic trainers report versus anonymous self-reported studies by players," said Bigosinski, who works at the Rush University Medical Center and is a team doctor for the Chicago White Sox, the U.S. Ski and Snowboard Association and DePaul University athletics. "It's 5-10 percent by trainers, but self-reporting by players went up to like 40-70 percent had a concussion in the past season. That means you are missing 9 out of 10 concussions sometimes. Someone didn't recognize the injury, or the player didn't tell anybody. That is a huge issue."
As such, the Pitt medical center study might be right. Concussion rates could be much lower during youth football practices than games. This makes intuitive sense, given that games are played with greater speed, intensity and violence while practices often involve far less hitting. On the other hand, the study might be wrong. It might be totally wrong. It's hard to say, because its methodology is inadequate. Likewise, the study's authors note that partial exposures -- that is, playing part of a practice or a game -- were recorded in the same manner as full exposures, thereby "potentially inflating the exposures and reducing the [incident rates]."
In other words: Almost all of the study's relevant numbers are iffy. Which means its headlining conclusion about practice being vastly more safe when it comes to concussions is also iffy. Nevertheless, Collins thinks boys should be hitting each other more often, lest they fail to learn how to hit each other in a consistently brain-safe way. This kind of thinking is balderdash. Complete and utter poppycock. As I've written before, there is no magic way to tackle that -- in the supremely dippy words of National Football League commissioner Roger Goodell -- "takes the head out of the game." Tackling is vicious. It is nasty. It's about getting low, applying force, inflicting pain and bringing another human being to the ground. Another human being who is actively trying to run your ass over. It involves the arms and the shoulders and a head that cannot be disconnected from the body. A "textbook perfect" tackle can still produce a dead child. If there really was a way to take the head out of tackling, football players wouldn't need to wear face masks. Or helmets, for that matter. And no one -- not even Collins nor Goodell -- is recommending that.
Still, don't take my word for it. Go find a rigorous study that demonstrates that additional full-contact practices reduce in-game concussion rates, and/or in-game subconcussive blows to the head. Hint: There aren't any. Better yet, take a look at what various sports leagues are doing. Hint: They're not listening to Collins. The Ivy League has mandated fewer full-contact practices. The Pac-12 reportedly will follow suit. The NFL has cut back on full-contact pre- and regular-season practices and eliminated them during the offseason. In Canada, the nation's hockey governing body has not pushed for more hitting in practice -- to the contrary, it recently banned pewee body-checking outright, in part because a five-year University of Calgary study found that Alberta youth players were four times more likely to suffer a concussion than youth players in Quebec, where hitting isn't allowed.
None of these leagues are stupid. They are neither panicking nor overreacting. Especially not the youth leagues. They understand that children are the most vulnerable, least protected athletes in harm's way. They know that if one concussion is bad, additional concussions are often worse, and that recovery takes up to two or three times longer if a child has sustained one or more concussions within the past year. They know that concussions aren't the only problem, that absorbing subconcussive blows over time has been linked with long-term cognitive harm, including the disease chronic traumatic encephalopathy. They comprehend basic math: fewer opportunities to get hit in the head = fewer opportunities to be concussed and/or suffer subconcussive trauma = less overall brain damage.
Heck, even the Pittsburgh study seems to grasp this: After noting that 19 of the 20 total concussions they recorded were suffered by quarterbacks, running backs and linebackers, the authors said that rotating those players to different, lower-contact positions -- that is, reducing potential exposures -- might ease the concussion risk.
If the study's conclusions don't make sense and aren't supported by compelling data, then why are Collins and his co-authors pushing it so hard? I honestly don't know. But I'll venture an informed guess. The Pittsburgh study does not list any conflicts of interest. This is highly questionable. Collins is a longtime medical consultant for the Pittsburgh Steelers. Co-author Joseph Maroon is a former member of the NFL's now-defunct concussion-denying, junk science-peddling Mild Traumatic Brain Injury Committee. As of last year, he was still a league consultant. The study itself was funded by a $100,000 NFL grant. And what is the league peddling when it comes to football-induced brain trauma? Two related lines of thought:
1. Brain trauma isn't the result of football itself, but rather of playing the sport incorrectly;
2. Consequently, individual players are personally responsible for the brain damage they suffer -- not management and ownership.
This is why the NFL has made such a big deal about cracking down on helmet-to-helmet hits. (Well, at least the open-field ones that are obvious on television; no one has yet suggested eliminating three-point stances to cut down on the helmet-to-helmet hits that happen along the line of scrimmage on every single play.) It's also why Goodell pursued Bountygate with Ahab-like zeal, and why the league is enthusiastically supporting USA Football's "Heads Up" youth tackling program, a warmed-over concept from the late 1960s that nevertheless has prompted organization executive director Scott Hallenbeck to state, "There is no question that the game can be played safely and is safe, as long as it is taught properly and the players execute it properly." Which, of course, means more full-contact practice. For children. So they can better execute.
After all, football isn't the problem. Football is never the problem. The 4,000-plus concussion lawsuits filed against the NFL alleging negligence and fraud are entirely without merit. The sport's feeder system and Ozymandias-shaming cultural cachet -- gaze upon me, ye baseballs and basketballs, and despair -- aren't facing an existential threat rooted in genuine human concern, but rather what ESPN Radio host Mike Golic calls a seeming perception issue that "youth league teaching can change." We have always been at war with Eurasia. A headline on the NFL's official health and safety informational website about the Pittsburgh study says it all: Study: Limited hits in practice might up concussions in games. Of course, the study says nothing of the sort. It suggests nothing of the sort. But no matter. More contact. Less brain trauma. Don't use your head, and it makes perfect sense.