Justin Moore wanted to play high school football after his sophomore year at Apex High two years ago, but his parents preferred that he play basketball.
His father, Wes Moore, thought the risk of injury was too high to allow the 5-foot-8, 185-pound rising junior to play football for the first time.
But last fall, Justin joined the Apex High football team and loved it.
“There has been nothing like it in my life,” Justin Moore said. “To run out on the field with your teammates under the lights and the crowd cheering and making noise. It was amazing.”
There are players such as Justin throughout the United States who are choosing to play football in the face of studies linking concussions with long-term health complications. After a five-year decline in high school football participation across the country, the National Federation of State High School Associations reported an upturn in 2013, when almost 1.1 million boys and girls played the sport.
Bob Gardner, the national federation’s executive director, says the increase suggests that many parents have been reassured that the game can be played without a high risk of brain injury.
Concussion management has been emphasized on the state and national levels. The federation has changed rules to reduce injuries. Every state in the U.S. has a law mandating concussion protocols.
“With the precautions that are in place nationwide to address concussions in all high school sports, including football, we have maintained that the risk of injury is as low as it ever has been,” Gardner said. “It isn’t much of an increase in football participation, but it is an increase.”
The N.C. High School Athletic Association has seen some fluctuation in the number of players, but not the steady decrease that had been registered nationwide before 2013.
The number of high school football players in the North Carolina in 2013 was an all-time high of 36,273. The number of players fell from 33,753 in 2006 to 29,5469 in 2007, but the number of players jumped more than 6,000 in 2009 and has been above 35,000 each year since.
“I believe parents are weighing the benefits of participating against the chances of an injury and are deciding the benefits outweigh the concerns,” said Davis Whitfield, the commissioner of the N.C. High School Athletic Association. “North Carolina has been in the forefront for years in keeping our children as safe as possible. That always is our No. 1 priority. Safety will always be the No. 1 priority.”
But there is still concern.
Nationally, at least four high school football players died this season from head trauma – including Isaiah Langston at Wake County’s Rolesville High, in September. According to the National Center for Catastrophic Sports Injury Research at the University of North Carolina-Chapel Hill, 17 players died from direct or indirect causes while playing high school football in 2013.
Various former NFL players, including Kurt Warner, have expressed qualms about their children playing football. NFL Hall of Fame quarterback Terry Bradshaw said he expects to see fundamental changes to the game.
The Illinois High School Association, which is similar to the N.C. High School Athletic Association, faces a class-action complaint that the association has been derelict in its duties to protect children.
A slight uptick
Gardner believes more high schoolers are playing because of changes made in recent years to help prevent concussions.
For example, the national federation changed rules governing where players line up on kickoffs. A player whose helmet comes off during play must leave the game until it can be properly fitted and secured.
Every state in the country now has legislation regulating the treatment of concussions on the interscholastic level. Many state associations, but not the NCHSAA, are limiting the amount of contact in practice.
“With the rule changes and the protocols, playing football may be safer than it has ever been,” Gardner said.
But there are still serious risks.
Langston, a Rolesville High linebacker, collapsed during pregame warmups on Sept. 26 and later died. According to the state medical examiner, he had been injured by a blow to the head in practice and had been held out of practice for two days. It is unclear whether a doctor had cleared the junior to return to football.
One of the dangers from concussions is returning to physical activity too soon, before the brain has healed, following an injury.
The brain is suspended in fluid within the skull. Physical force can shake the brain or cause it to strike the inside of the skull. The movement can disrupt the chemical reactions within the brain, which is a traumatic brain injury or a concussion. If the brain is shaken again while still healing, the results can be fatal.
The accepted treatment for concussions is rest. Athletes are told not return to competition or practice until they no longer have any symptoms, which can include headaches, blurred vision, nausea, light sensitivity, confusion, memory loss or a wide assortment of indicators that the brain is not functioning at its normal level. The symptoms usually clear up within a few days.
New rules after concussions
Jaquan Waller, a player at Greenville J.H. Rose High School, died during a game in 2008 after being tackled. He had been concussed during practice earlier in the week. Matthew Gfeller of Winston-Salem R.J. Reynolds died that same year after being hit in a game.
The two deaths prompted the state General Assembly to pass the Gfeller-Waller Concussion Awareness Act in 2011.
The law requires every public middle school and high school in the state to educate players, coaches and parents about concussions; to develop an emergency action plan; and to implement a post-concussion protocol that must be followed before a player with a suspected injury can return to play or practice.
But there is no penalty for violating the law. And the law is being violated.
The N.C. Department of Public Instruction audited the state’s high schools and found 13 of 115 districts were not in compliance. Most of the violations were for things such as failing to have an emergency action plan posted at every athletic venue, according to Que Tucker, a deputy assistant commissioner of the NCHSAA.
“A key point is that a big majority of the state’s systems were in compliance,” said Burt Jenkins, a healthful living consultant for the department, which asked the NCHSAA to develop penalties for member high schools that are in violation of the law.
Whitfield, the NCHSAA commissioner, said the proposed measures would include fines and other penalties for different infractions. Failing to have a parental signature on a form describing the dangers of concussions and concussion symptoms might carry one fine and not following return-to-action protocols would have another.
If a school failed to get a parental signature, for instance, the player could be ruled ineligible and any game in which the player participated might be forfeited.
“The biggest goal is to educate,” Whitfield said. “The fines and penalties are to help get their attention.”
The NCHSAA has no authority over middle schools, which also are covered by the Gfeller-Waller Act. Recreation and youth league teams and prep teams at schools that are not a part of the NCHSAA are not covered by the state law.
Thirteen states have laws that cover all youth sports, not just high school and middle school athletics. Colorado, for example, requires concussion education for all coaches who work with children from 11 to 18 years old.
Kevin Guskiewicz, the head of the Matthew Gfeller Center, a sports-related traumatic brain injury research facility at UNC-Chapel Hill, said the legislature considered having the law cover all youth sports.
“There were questions about how you enforce it,” Guskiewicz said. “The key may be that you regulate groups that use public fields. Expanding the law might be the next step.”
Bob Cantu, a prominent concussion expert, says children should not be allowed to play any collision sport, including football, before the age of 14 because adolescent brains still are developing. Several states have limited the amount of contact allowed during a week of football practice.
A legal challenge
Joseph Siprut, a lawyer who brought a class action suit against the NCAA on the concussion issue, has filed a class action suit against the Illinois High School Association for not doing enough to protect high school football players.
Siprut told CNN that his goal is to challenge every high school athletic association in the country.
The 2013 increase in participation puts 1.1 million high school players on the football field, compared to about 68,000 NCAA football players. All of the football-related deaths during the last two years have involved high school players. None were reported in professional, college or youth football.
The NCHSAA’s Whitfield said the association will watch the Illinois lawsuit closely.
“I believe that the NCHSAA has been a national leader in concussion awareness,” Whitfield said. “Even before the Gfeller-Waller Act we had our Sports Medicine Advisory Committee working to develop policies and procedures.”
Justin Moore was a member of Apex’s 2013-14 boys basketball 4A state championship team. He’s glad he persuaded his parents to let him play football.
“I wanted to play and my friends wanted me to play,” Justin said. “It was going to be my last chance.”
His dad did not make the decision lightly.
“We had concerns,” Wes Moore said. “But the Apex coaches did a tremendous job addressing our concerns. We learned about the precautions and the things that are in place. The year was tremendously successful. Justin really enjoyed playing and being with his teammates.”
Justin Moore said he did not dwell on the possibility of getting hurt.
“You don’t worry about that stuff,” Justin said. “You are probably not going to get a concussion.”