On a cool August morning in Napa, the Oakland Raiders and Detroit Lions gathered on the grassy fields behind Redwood Middle School for a joint training camp practice.
After a long offseason, the sound of cracking pads and quarterback cadence signaled the return of NFL football. Eager spectators filled metal bleachers overlooking the action, welcoming the early signs of the coming season. The crowd included players from a pair of local high school teams.
Following the practice, Raiders head coach Jon Gruden was asked about having those young athletes in attendance. What did it mean to him? Why bring them out? His answer was emphatic.
“I think it’s smart for everybody at this level, pro football, NFL, to give back to youth football,” Gruden said. “We’ve got a problem, I think, in this country. The game is under siege by a lot of people who don’t think it’s a safe game. They don’t think it’s a good game anymore. And I think that’s hogwash.”
Gruden’s passion speaks to the growing debate surrounding youth football. Many love the sport. But mounting evidence shows that playing football can be extremely dangerous, even deadly in the long run. Is it a good idea for young players to participate? That is an increasingly louder discussion.
By almost any measure, football remains the most popular sport in the United States, a fact reflected by the number of those who play it. According to the National Federation of State High School Associations (NFHS), more than 1 million boys played football nationally in 2017 — nearly equaling the totals of basketball and baseball combined. Thousands more suited up for youth leagues like Pop Warner, beginning as early as age 5.
Yet those numbers are decreasing. The number of high school boys playing tackle football has been in slow but steady decline for nearly a decade. The trend has coincided with heightened concern about the frequency and lasting impact of head injuries on young athletes — with former NFL stars among those questioning whether they’d let their sons play football, and some states weighing whether to establish minimum age limits for the sport.
A recent Friday night in the Bay Area provided a jarring snapshot of football’s risks. On Sept. 21, Heritage-Brentwood and Freedom-Oakley each had a player airlifted to a local hospital after sustaining in-game injuries. Another game between Benicia and St. Patrick-St. Vincent-Vallejo was reportedly cut short after several SPSV players exited with injuries. The injured players from Heritage and Freedom were both released from the hospital shortly thereafter, according to team and school officials.
Such incidents have led some parents and players to consider other options.
Overall, participation in 11-player football fell about 6.9 percent between the 2008 and 2017 seasons, according to the NFHS.
The trend has led Roger Pielke Jr., director of the Sports Governance Center at University of Colorado, to study the numbers and draw a conclusion.
“There’s enough evidence to say that football, as a youth sport, has peaked,” Pielke said.
Counter to an overall increase in the number of high school athletes nationwide, participation in football declined by more than 75,000 players from 2008 to 2017. Some states gained players in that span, including Florida (3.5 percent) and Texas (2.3), according to the NFHS. Others saw large decreases in participation, including Ohio (23 percent), Michigan (21.6) and New York (21.2).
The total number of schools offering football stayed consistent over that time. But while states such as Florida (77 more), Tennessee (35) and Georgia (38) added programs, others had more schools drop the sport. There were net decreases of 46 programs in Ohio, 51 in Oklahoma and 36 in Iowa.
Chris Boone, NFHS assistant director of communications and publications, said one factor may be athletes branching out, explaining that areas where football numbers have dipped “tend to be states that have introduced new and emerging sports.”
Football-related injuries represent another major concern.
Efforts have been made to research those injuries. One study sponsored in part by the NFHS is the National High School Sports-Related Injury Surveillance Study, a tool that gathers weekly online reports from certified athletic trainers at a national sampling of high schools and uses the data to analyze injury patterns and trends.
The study, begun in 2005 by Dr. Dawn Comstock, now of the Colorado School of Public Health, estimates the rate of high school sports-related injuries per athletic exposure — competitions and practices at which an athlete was exposed to potential injury.
Football’s injury rate has consistently been the highest among sports tracked by the study. In 2017-18, the study estimated a rate of 4.33 injuries per 1,000 exposures in football, compared with a rate of 2.45 per 1,000 overall in prep sports. It was the third-highest annual injury rate for football in the 13 years of the study, up from 3.56 per 1,000 exposures in 2016-17, which was the third lowest.
Most football injuries, according to the study, occurred from being tackled or tackling. Most happen between the 20-yard lines and to those playing the positions of running back, linebacker and receiver.
But while those trends stayed constant, there was a notable shift in diagnoses. In 2006-07, the study’s most commonly diagnosed football injury was an ankle sprain or strain (12.5 percent), followed by concussions (10.4 percent). Eleven years later, concussions accounted for 26.3 percent of reported injuries — likely due at least in part to increased scrutiny of head injuries.
Comstock said the increase in reported concussions has occurred in all sports monitored by the study, not just football.
“We’ve had an intense focus on this issue over the last decade-plus,” Comstock said. “There probably aren’t that many more concussions that are occurring now than before. But when a concussion does occur in a high school athlete, in the past too many of those were going unrecognized, undiagnosed. And now fewer are going unrecognized and undiagnosed.”
In California, where 11-player football participation has fallen almost 10 percent over the past decade, the governing body for high school sports has adopted policies geared toward player safety, said California Interscholastic Federation executive director Roger Blake.
A standing rule requires players in all sports to be removed from games or practices if they show signs of concussion and to be cleared by a doctor before they can return. Beginning in 2018, the CIF halved the amount of full-contact hitting allowed in football practices to a total of 90 minutes per week over two days.
“The science kept telling us less is better,” Blake said. “So listening to the sports medicine people, our docs, that’s the direction we’ve followed with our schools.”
Still, fewer high school students are playing football. And Blake said the CIF frequently hears the same explanation from its coaches.
“They’re saying youth programs in football, at the local level, those numbers have declined,” Blake said. “So they can anticipate the number of kids coming up is going to decline.”
Central to the debate around football: At what age, if any, should children be allowed to begin playing?
Medical research increasingly shows a link between repeated head impacts and long-term brain disease, including chronic traumatic encephalopathy, or CTE, a progressive degenerative brain disease found in people who have experienced brain trauma.
According to the Centers for Disease Control and Prevention, “it is not yet known how many repeated head or brain injuries increase the risk for CTE,” but the “greatest risk factor for CTE is the number of years of exposure to repeated head or brain injuries.”
It’s one reason Chris Nowinski, co-founder of the Concussion Legacy Foundation, which is dedicated to head injury research, supports the idea of restricting tackling before high school. The brain, he said, is still developing at that time.
“The brain is going through incredible changes between the age of 8 and 13,” Nowinski said. “You don’t have to be a neuroscientist to think it’s a bad idea to hit a child in the head hundreds of times at the most critical point of their brain development.”
That concern has gained high-profile exposure in recent years.
Hall of Famers Brett Favre and Mike Ditka, along with former running back Bo Jackson, have all publicly said they would dissuade their sons from playing football. In 2014, then-President Barack Obama was quoted in the New Yorker as saying he “would not let my son play pro football.”
Some lawmakers have suggested taking the decision out of parents’ hands — though without much success.
By April of this year, bills had been introduced in five states proposing to ban tackle football at the youth level. A Maryland bill that would have prohibited tackling before high school was shot down in March by a committee vote. Measures in Illinois, New York and New Jersey proposing to outlaw tackle before age 12 weren’t expected to gain much traction.
In California, the Safe Youth Football Act calling for a ban on tackle football before high school (and later amended to age 12) received swift backlash after it was introduced in February. Its opponents circulated an online petition that collected more than 40,000 signatures and rallied outside the State Capitol. The bill was pulled in April prior to a committee vote.
Some youth programs have taken their own action. USA Football, youth football’s governing body, established guidelines in 2015 limiting contact to 30 minutes per practice, 120 minutes per week in preseason and 90 minutes per week in the regular season. In 2017, USA Football reported more than 7,000 youth leagues and about 3,400 high schools enrolled in its “Heads Up Football” player safety program.
In 2016, Pop Warner eliminated kickoffs, considered one of the sport’s most dangerous plays, in its three youngest age divisions. It also reduced the amount of contact time allowed in practice from 33 percent to 25 percent.
Still, youth leagues have seen their numbers dwindle. Participation in youth football dropped nearly 30 percent between 2008 and 2013, according to the Sports & Fitness Industry Association. That trend has extended to parts of the Bay Area.
Andre Hunt, president of Coyote Creek Youth Sports in San Jose, said the club used to be able to field teams in all six divisions of Pop Warner, averaging 30 to 35 players per team. This year, Hunt said, Coyote Creek has four teams totaling about 130 players. Hunt said factors include safety concerns, but also changing demographics and costs of equipment and fees to families.
“People talk about the concussion part, and yes, with certain parents that is a concern,” Hunt said. “With other parents, it’s not a concern enough to keep them from allowing their kids to play football. But for those parents, the economics become a real concern.”
The East Bay Panthers, a member of American Youth Football, merged with another team last year to stay active due to low enrollment, said President Jacob Davis.
“Most of the parents are worried about the concussions,” Davis said.
Davis said the Panthers test players with HitCheck, a smartphone concussion testing aid, before games and during if they sustain a big hit. The club also teaches Hawk Tackling, a rugby-style tackling technique popularized by the NFL’s Seattle Seahawks that is designed to avoid use of the head.
For years, mounting evidence has linked football violence with brain trauma and life-threatening conditions. Now that we know the sport can produce deadly results, where do we go from here?
Today: Youth football participation is a telling sign of things to come. B1
Tuesday: What will the future of football really look like?
Online: Read the full series online now at www.sfchronicle.com/future-of-football
One evening this June, the Panthers and the San Leandro Crusaders gathered at Burrell Field in San Leandro, where each team received a grant of $50,000 through the Dick’s Sporting Goods Foundation, its Sports Matter youth outreach program. The presentation was made by Gruden, the Raiders’ coach, who also gave a pep talk to the players and ran a few of the older kids through drills.
Gruden became involved with the Sports Matter program in 2014 while working for ESPN, saying he noticed numbers declining in youth and high school football.
“There’s some fear out there,” Gruden said. “I think people are missing the boat. I think they’re just hearing the negative stories all the time. They don’t really hear from people like me, or people that played the game, that really benefited by learning their work ethic, sportsmanship, their mental and physical toughness and all the discipline and accountability you have to have.
“It’s not an easy game. I just want kids to play if they want to play. I don’t want people to make the decision for them.”
Jason Tatum, who’d brought his son, Cameron, 11, a wide receiver and quarterback, to Burrell Field, said the potential for head injuries in football is concerning.
“Watching them over the years, they don’t really do a lot of helmet-to-helmet tackling,” Tatum said. “As they get older and guys are hitting harder, then maybe we’ll shift sports. But right now it’s just really good exercise for them, gives them a really solid sense of discipline.”
Already, the overall ebb in football participation has Pielke, the Colorado professor, wondering about the long-term implications for the nation’s most popular sport. The current rate of decline at youth and high school levels likely won’t affect the college or NFL levels for years. But will the current rate remain steady? Might it be a precursor to something more dramatic?
“It’s a guess,” Pielke said, “but I’m pretty confident it’s not going to turn around and zoom to new numbers anytime soon.”