The safety of youth sports, particularly high school football, has brought significant attention to conditions like chronic traumatic encephalopathy (CTE). Parents, athletes, and coaches are increasingly concerned about the potential long-term neurological consequences of participation. This concern often leads to a central question: can playing high school football contribute to the risk of developing CTE?
Understanding CTE
Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative brain condition linked to a history of repeated head impacts. Unlike an acute injury, CTE is a long-term neurological disease that worsens over time, sometimes leading to dementia. It is characterized by the abnormal accumulation of a protein called tau within the brain, particularly around blood vessels and in specific cortical layers. This tau buildup disrupts normal brain function, leading to brain atrophy.
Individuals diagnosed with CTE post-mortem often experienced a range of symptoms. These can include cognitive impairments such as memory loss, thinking and planning difficulties. Behavioral changes like impulsivity, aggression, and mood disturbances, including depression and anxiety, are also commonly reported. Movement symptoms, such as problems with walking and balance, can also manifest as the disease progresses. Symptoms typically appear years or even decades after the head trauma occurred, often presenting in two forms: earlier onset with mental health and behavioral issues, or later onset around age 60 with memory and thinking problems.
The Link to High School Football
Repetitive head impacts sustained in contact sports, including high school football, are associated with an increased risk of developing CTE. This risk is not solely tied to diagnosed concussions, but also significantly to repetitive sub-concussive hits—impacts to the head that do not cause immediate, noticeable symptoms. The cumulative effect of these impacts over many years, particularly during critical periods of brain development, plays a substantial role.
Studies analyzing the brains of deceased football players have shown a relationship between the duration of play and the likelihood and severity of CTE. For instance, every additional year spent playing football has been associated with a 15% increased chance of a CTE diagnosis. The intensity and number of head impacts, rather than just the number of diagnosed concussions, appear to be a primary driver of CTE risk. High school linemen, for example, can experience between 1,500 and 1,800 sub-concussive hits in a single season.
Those who begin playing tackle football at younger ages may experience cognitive and behavioral symptoms of CTE earlier in life. One study found that for every year younger a person started playing football, the reported onset of CTE symptoms occurred approximately 2.5 years earlier. Ongoing research highlights the importance of understanding the long-term effects of head impacts on the developing brain.
Distinguishing CTE from Concussion
A concussion is an acute traumatic brain injury (TBI) resulting from a sudden bump, blow, or jolt to the head. Symptoms such as headaches, confusion, memory issues, or dizziness typically appear immediately or within hours of the injury and are often temporary. Most individuals recover from a single concussion with rest, and one concussion usually does not cause permanent brain damage.
Conversely, CTE is a progressive neurodegenerative disease that develops over an extended period, often years or decades after repetitive head trauma has ceased. While concussions are acute events, CTE is believed to stem from the cumulative effect of repeated head impacts, which can include both concussions and sub-concussive hits. Not every person who experiences repeated concussions will develop CTE, and some individuals diagnosed with CTE had no history of diagnosed concussions, underscoring the role of sub-concussive impacts. The diagnosis of CTE currently relies on post-mortem examination of brain tissue, whereas concussions are diagnosed based on symptoms and clinical evaluation.
Mitigating Risks in High School Football
Efforts are underway to make high school football safer by reducing the risk of head trauma. Rule changes have been implemented to address dangerous contact, such as targeting rules that penalize hits above the shoulders, aiming to minimize helmet-to-helmet contact. Kickoff rules have also been modified in some cases to reduce high-speed collisions.
Coaching techniques are evolving to promote safer play, with programs like USA Football’s “Heads Up Tackling” teaching players to tackle with their shoulders and avoid leading with the helmet. This approach emphasizes proper body mechanics to reduce head contact during tackles and blocks. Equipment advancements, such as optional Guardian Caps that fit over helmets, are being explored to further reduce impact forces, though helmets primarily prevent skull fractures and severe brain injuries, not necessarily concussions or sub-concussive impacts.
Enhanced medical protocols are also crucial for player safety. These include improved concussion recognition and immediate removal from play for any suspected head injury. Strict return-to-play guidelines ensure that athletes are medically cleared before resuming activities, allowing their brains to heal properly.