For Eddie Mason, the decision wasn't difficult.
The NFL veteran's 10-year-old son, Tyler, won't play tackle football until high school.
Mr. Mason's decision wasn't a result of the burgeoning national discussion about football's role in brain injuries. Instead, he believes children should learn the game's fundamentals without tackling. Mr. Mason, who played three seasons at linebacker for the Redskins before retiring in 2003, sees a problematic culture infecting football's lowest levels that's inextricably connected to the safety concerns.
"This brash kind of mindset, the underdog mindset," Mr. Mason said, "this hard-core attitude kind of deal about who hits the hardest [is part of the issue]. If you look back over the last eight to 10 years, players showing up in the NFL are technically unsound. We're eight to 10 years behind developing fundamentals for how to play the sport.
"Compound all these factors into one lump and it's just a bomb about to explode."
That's already started. As mild traumatic brain injury and chronic traumatic encephalopathy have become household phrases, participation in the country's most popular sport has slumped.
During the 2012-13 season, boys' participation in 11-player high school football declined to the lowest level since 2005-06, according to the National Federation of State High School Associations. Football, however, remained the most popular high school sport.
USA Football, an umbrella organization partially funded by the NFL, estimated the number of children ages 6 to 14 playing tackle football decreased from 3 million in 2010 to 2.8 million in 2011. The National Sporting Goods Association reported that tackle football numbers dropped 11 percent since 2011.
And participation in the country's largest youth football organization, Pop Warner, declined 9.5 percent from 2010 to 2012, as first reported by ESPN's "Outside the Lines."
"There's a natural ebb and flow in the popularity of sports but I do think that the concern about concussions, concern about the brain injuries, is also a major cause for concern in parents," said Dr. Julian Bailes, co-director of NorthShore University HealthSystem's Neurological Institute in Evanston, Ill., and Pop Warner's chief medical officer.
Added neurologist Dr. Robert Cantu: "I think that's purely a reaction to parents becoming aware of both post-concussion syndrome and later-life consequences."
Sorting out the future
The drop comes as 4,843 former NFL players, according to a count by The Washington Times, sue the league over brain injuries. The plaintiffs include Mr. Mason plus 36 living and deceased members of the Pro Football Hall of Fame. A proposed $765 million settlement reached in August hasn't been filed in federal court for approval. At least six concussion-related lawsuits have been filed against the NCAA, too.
But football's long-term future is being sorted out by parents and their children on fields far from television cameras and big-money contracts and stories about some former professional players struggling with post-football health.
A survey released earlier this month by the Robert Morris University Polling Institute showed 40.5 percent of respondents supported a ban on children playing tackle football before high school. Almost half of respondents (49.3 percent) would encourage their children or others to wait until high school before starting tackle football.
An October poll by HBO's "Real Sports" and Marist College echoed the concern. A third of respondents said links between football and long-term brain injury made them less likely to allow their son to play football. Even more — 56 percent — believed that long-term brain-injury risk was an "important factor" in whether they allowed their son to play football.
These are the changing attitudes Dustin Fink encounters each day. An athletic trainer in Illinois, he tracks the issue at The Concussion Blog. The recent comments of two fathers Mr. Fink thought were hard-core football supporters shocked him. They weren't going to let their sons play tackle football until high school.
"I've never seen dads admit as much until now," Mr. Fink said.
He is far from anti-football, but reached a similar conclusion about his two young sons. Until high school, they'll stick with flag football.
"It's a bloodsport, but in the proper context it can be played," Mr. Fink said. "I love football. I don't want it going anywhere. I'm not trying to ruin the sport — I'm trying to save it."
Mr. Fink points to the inherent contradiction of the most attention about brain injuries, the strictest protocols, the most studies, the most education being directed at professionals — the smallest population — while millions of youth players have the loosest regulation. The NFL, for instance, limits full-contact practices to 14 during the regular season, employs strict procedures for players to return from concussions and has an unaffiliated neurologist on the sideline at each game in addition to the usual platoon of athletic team doctors, trainers and emergency medical personnel.
"At the youth level, you're lucky to get someone's mom who is a nurse on the sideline," said Mr. Fink, who believes athletic trainers should be mandatory at high schools offering collision sports. "Football won't live on forever with the way it's currently constructed, that's flat-out fact in my mind."
Measuring depth of damage
At least six high school football players died this year after on-field collisions. The tragedies involve a small fraction of the million-plus participants, but point to the growing body of studies about the impact of head injuries among youngsters.
The Institute of Medicine said high school football players were twice as likely as their collegiate counterparts to sustain concussions and that football had the highest such rate of any high school sport. Between 4 percent and 20 percent of high school football players will sustain a brain injury over the course of one season, the American Association of Neurological Surgeons estimated. Players as young as 7 years old sustain head blows on a par with high school players and adults, researchers at the Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences found.
The Centers for Disease Control and Prevention reported football as the most common reason for emergency room visits by children for nonfatal traumatic brain injuries from 2001 to 2009. That doesn't count undiagnosed concussions or ones deemed too mild for a hospital trip.
Dr. Cantu hopes for a 10- to 15-year study to quantify the long-term impact such collisions have on youth players.
"I fear the incidence is much higher than we ever believed," he said.
The doctor, a senior adviser to the NFL's Head, Neck and Spine Committee and co-founder of the Sports Legacy Institute, isn't shy about his belief flag football should replace the tackle version until age 14. The age is admittedly arbitrary, an attempt to steer children toward things that don't hit back as their brains develop.
"Some people understand the issues," Dr. Cantu said. "Other people would wish we'd never brought up the subject. I totally understand it. If USA Football and Pop Warner go away, you have a lot of people who aren't going to have jobs."
Dr. Bailes, on the other hand, pushes for widespread practice limits, already instituted by Pop Warner in 2012, along with taking linemen out of the three-point stance and decreasing head impacts. He believes the velocity and frequency of those impacts among youth players are less than seen at higher levels.
"Overall this is a very safe activity," he said. "You've got to put it in the context of alternative activities."
Technique before tackling
One of those alternative activities is flag football. In addition to working with athletes of all levels at Mase Training in Sterling, Mr. Mason is commissioner of a local i9 Sports youth flag football league. Turnout more than doubled this fall, from 720 players last season to 1,475. Mr. Mason attributes the growth, in part, to parents concerned about brain injuries in the sport's contact version.
"There's no fear of the game," Mr. Mason said. "They don't have to worry about getting hit."
Three players still suffered concussions despite the lack of hits, something he sees as an unavoidable risk of most recreational activities.
Flags, rather than tackles, provide opportunity, in Mr. Mason's eyes, to develop fundamental skills he finds wanting at every level of football. Mr. Mason didn't play tackle football until ninth grade. That helped shape the desire to have his son learn how to take a handoff, make cuts and control his body before pads and helmets come out.
Mr. Mason favors a progressive model to train youngsters in the game's basics with flags, from proper technique to play defensive back to how to enter a tackle in the proper fashion, before moving to soft pads and, finally, full contact in high school in hopes of reducing head injuries and producing technically sound players. Unqualified coaches at youth levels and a culture that values big hits over sound technique worry Mr. Mason. He believes both issues are feeding a stigma among some parents that the game is unsafe.
"The object is to tackle this guy, not try to hit the guy as hard as I can," Mr. Mason said. "We're not modern day gladiators. We're not supposed to be building a bunch of kids bent on, 'Man, I want to knock this guy out.'"
The decline in football participation, whatever the reason, doesn't surprise him.
"I think there's a way we can really head this issue off and bring safety back to the game," Mr. Mason said. "But it's just going to take time."
That means culture. Technique. Mindset. Everything for football to get back up from the latest hit.
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