Familiar sounds filled the air at Blue Valley Northwest High School’s first football practice of the year.
Rock music playing over the sound system. Whistles blaring. Coaches yelling instructions.
But one sound wasn’t present: helmets colliding.
That’s because the Kansas State High School Activities Association, or KSHSAA, approved new rules last year limiting full-contact football practice.
Players aren’t allowed to go all-out until the fifth practice. Once games start, full-contact practices are limited to an hour and a half, and contact isn’t allowed the day after games.
The new rules — formed with help from the National Federation of State High School Associations Concussion Summit Task Force — are meant to reduce players’ head injuries and brain trauma that have parents increasingly asking whether football is right for their kids.
Not everyone is a fan.
“I personally don’t like the limited contact setting because you’re not allowed to go 100 percent, basically, and I just can’t play football like that,” said Garret Tierney, a senior running back and linebacker at Blue Valley Northwest in Overland Park.
But Tierney said his mom and grandparents are concerned about the connection between football and head injuries.
Tierney doesn’t think he’s ever had a concussion. But concussions aren’t the only worry when it comes to football.
Researchers at Boston University have studied the brains of people who played football at several levels — high school, college and pro — and found some indication of chronic traumatic encephalopathy (CTE), a degenerative brain disease, at all levels.
One of the brains came from Zack Langston, who about 10 years ago was a hard-hitting linebacker at Blue Valley Northwest who would go on to play at Pittsburg State University.
Langston fatally shot himself in the chest in 2014 after years of battling mood swings and rage characteristic of severe CTE. He was 26.
Acute concussions are the most obvious types of brain injury. But CTE like Langston had builds slowly, over time, and so far can only be diagnosed after death. That makes it hard for high school players, and their parents, to know exactly what risks they’re facing.
NFL kick returner and wide receiver Josh Cribbs held a room full of reporters riveted when he spoke as part of a panel discussion about head trauma at the April conference of the Association of Health Care Journalists.
Cribbs talked about gaming the NFL’s concussion tests to stay on the field, even after he’d been hit so hard he blacked out temporarily. He talked about being knocked out for multiple commercial breaks, then coming to and looking at the scoreboard to see who his team was playing.
Steve Sanders, a former NFL player and friend of Cribbs who also was on the panel, shook his head.
“Even though I’m hearing this for probably the 10th time, I’m sitting here like ‘Wow,’” Sanders said.
Cribbs said a neurology specialist told him he has “unspecific change in my white brain matter,” but neither the specialist nor anyone else could tell if it’s the buildup of tau protein that causes CTE.
“I had a brain MRI and CAT scan and everything recently with the clinic, and I had my doctor tell me I have a healthy brain for a person in their late 50s,” Cribbs said. “I’m 32 years old.”
But Cribbs has played a decade in the NFL, following four years at Kent State University.
How much risk he would have faced if his football career ended after high school is hard to evaluate.
Charles Bernick, associate medical director for the Cleveland Clinic’s Lou Ruvo Center for Brain Health, said during the panel discussion that there’s scant research on CTE among student-athletes.
“There’s just not a lot on that,” he said, “and that’s why in these decisions and discussions of youth football, we don’t have a lot of hard facts to guide that or to absolutely say, you know, it’s dangerous.”
Bernick said the number of blows to the head is the biggest contributing factor for CTE, but other factors likely are at play as well: genetics, lifestyle, environment. Two people who get hit the same number of times aren’t likely to react the same way.
“We know trauma is necessary, but we don’t know the other risk factors,” Bernick said. “We don’t have any consensus in the diagnosis of CTE, and we don’t have any way to really diagnose it in imaging at the moment. All these things people are working on, but you have to understand at this level there’s a lot of unknowns in work on CTE.”
Other sports also carry risks
More research on head trauma is underway at places like Boston University, the National Institutes of Health and the Department of Defense.
Since 2011, Bernick has been studying the brain function of athletes — not just football players, but boxers and mixed martial arts fighters as well.
He said CTE has affected hockey players, while veterans of recent wars in Iraq and Afghanistan who survived blast injuries also could be susceptible.
Former pro soccer player Brandi Chastain has agreed to donate her brain for research after death, providing more insight for studies that thus far have focused almost exclusively on the brains of male athletes.
KSHSAA officials like Brent Unruh, a certified athletic trainer who is the association’s sports medicine liaison, said the focus on football shouldn’t obscure the fact that all sports carry some risk of head injury.
“Girls’ soccer this past year actually has their overall concussion rate the same or even a little higher than football,” Unruh said, citing data collected by athletic trainers nationwide. “It’s the first time that it’s reached that level. So it’s definitely not just football.”
Still, football has taken the brunt of CTE awareness, with youth participation numbers dropping for several years before a slight rebound last year.
The head football coach at Blue Valley Northwest, Mike Zegunis, said he thinks the sport has not received enough credit for safety improvements, whether it’s the new contact limits or coaching that emphasizes proper blocking and tackling techniques.
“There’s so much good that can come from kids playing football, I think it would be a tragedy if we started losing more and more people because of what the game of football can do for teaching boys to become men,” said Zegunis, who’s entering his 12th year coaching the Huskies.
Mark Lentz, KSHSAA assistant executive director, said the contact limitation rules are in place so kids can enjoy the benefits with fewer risks.
“We’re not guaranteeing that someone’s not going to get a concussion, which no one can do,” Lentz said. “But we’re minimizing the risk. … Does this mean it’s the perfect system? I don’t know. But is it something we believe that can be built upon? Absolutely.”
Correction: An earlier version of this story incorrectly referred to the Kansas State High School Activities Association.
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach him on Twitter @andymarso