(Boston) – An audit of how well state high school football associations are adhering to 2014 national guidelines intended to reduce the risk of head trauma and concussion shows that two years later, only 12 of 50 states are meeting even three of the five guidelines.
The national guidelines were issued in 2014 by the National Federation of State High School Associations (NFHS). The audit was conducted by Diana Coyne of Connecticut and Dorothy Bedford of Pennsylvania, both volunteer concussion safety policy advocates.
According to a metric they devised, the audit results show that only 24 percent of states are in compliance with the guidelines for limiting pre-season practice, while 38 percent comply with in-season guidelines. Since 2012, 44 states have introduced some limits, beginning with Texas, but specific policies vary widely.
Over a million students play high school football in the United States. Every day those student athletes enjoy the benefits of sports, with a small but real risk of brain injury.
“As much as we want to encourage fitness and teamwork, reducing unnecessary risk is common sense,” said Bedford, a former school board member in New Jersey. “Students deserve to complete their high school football careers with brains intact, ready for further studies, the workplace, or military service, plus healthy personal relationships. Lasting concussion symptoms may adversely impact all aspects of personal and family life.”
In addition to recommending guidelines for limiting full-contact practice, NFHS also directed state associations to review their football programs for activities which accumulate a substantial amount of head impacts. Based on their findings, Bedford and Coyne sent a letter to the NFHS that includes a request to transition the guidelines into formal rules.
The timing of the NFHS guidelines coincided with new research finding chronic traumatic encephalopathy (CTE), a degenerative brain disease that appears to be caused by repeated trauma, in multiple deceased high school football players, including one only 17 years old. CTE research shows that risk appears to be better correlated to total brain trauma exposure – the number of hard hits to the head - rather than concussions.
Activities correlated with exposure include number of scrimmages and weekly game time allowed. Thirteen states allow three or more scrimmages in the pre-season period, which expands the total number of contests by up to 33 percent. Twenty-three states allow players eight or more quarters per week, which may increase the amount of contest play for a single athlete by 100 percent. A notable gap in recommendations is the practice that a small number of players play “two ways,” meaning that while some starters play offense or defense, playing fewer than half the plays in a game, a handful of stand-out players are on the field every play of the game.
“It is long overdue that NFHS develop rules to address two-way play,” Coyne said. “This dangerous practice only happens at the high school level; it is widespread, and is typically done for no other reason than to win games, as it is limited to the best few athletes.”
Coyne and Bedford met through event programming of the Concussion Legacy Foundation. The Concussion Legacy Foundation was the first group to propose football practice contact limits, and helped create them as advisors to the National Football League Players Association and the Ivy League, the first two organizations to successfully implement them. At the time, Coyne was working on updating Connecticut’s concussion (Lystedt) legislation and Bedford’s Princeton, New Jersey school board had just adopted Ivy-League style practice limits, the first high school to do so in New Jersey. Those experiences inspired them to start tracking the adoption of policies limiting full contact practice, as well as sharing their findings among state associations studying the issue.