Health issues in American football

There a number of issues relating to public awareness and health aspects of American football. Since the invention of the game, it has seen a higher injury and death rate than most other major American sports.^{[citation needed]} Several universities have been criticized for allegedly valuing wins and losses above the educational welfare of the student-athletes.^{[citation needed]} The extent of steroid use also has some controversy attached to it.

Injuries

Tackles are one of the leading causes of injuries in American football

Many players currently in the NFL have needed surgery to repair injuries that might have otherwise ended their careers. An "Injury Report" section is ubiquitous in American newspapers' sports sections, detailing, for each injured player on each team, his injury and the amount of time he is expected to be out. Twice-weekly (Wednesdays and Fridays) during the season, all NFL teams must report the status of their injured players, or be subject to a fine from the league. The standard severity descriptions are "out" (will not play in the coming game); "doubtful" (25% chance of playing); "questionable" (50% chance of playing); or "probable" (75% chance of playing). Teams occasionally manipulate their injury reports, minimizing or maximizing the extent of a player's injury, as an attempt to strategically deny their upcoming opponents a clear picture of the team's health. The origin of the injury report was to combat gamblers gaining inside information from players.

The NFL has a roster limit of 53 players per team during the season; 46 of which dress for a game. Players who are injured are frequently among the seven that do not dress. If it becomes certain that a player will not play for the rest of the season, the team may put him on the "Injured Reserve" list and replace the player on the roster.

Brain injury

Players in the National Football League have a high risk of brain related injuries. The Concussions Committee of the NFL, co-chaired by Dr. Ira Casson, has generally denied that concussions result in permanent brain injury. However, there is some^{[citation needed]} research, reported in 2009, which, using phone interviews based on the National Health Interview Survey,^{[citation needed]} showed increased incidence of diagnosis of memory loss and dementia among retired professional football players. Such symptoms are believed related to the effects of concussion. More rigorous research is being conducted by Dr. Casson^{[citation needed]}, neurologist, for the N.F.L. This finding is considered significant as such injuries may potentially affect high school and college players also. On average, there are 4-6 minor injuries and 1 major injury (including, broken bones, brain damage, etc.).^{[citation needed]}

An estimated 43,000 to 67,000 players endure a concussion during every high school football season, though because many such injuries go unreported, that number may well exceed 100,000, as noted by a Purdue University and Indiana University study published in the Journal of Neurotrauma, “Functionally-Detected Cognitive Impairment in High School Football Players Without Clinically Diagnosed Concussion." That study also examined the health of 21 players throughout the course of a season. The 21 players experienced 15,264 significant collision events across 48 practices and games (an average of 15.5 collision events per player per organized activity); four of the 21 players were diagnosed with a concussion. The study also found that a portion of the players with no clinically observable signs of concussion still showed significant functional impairments when observed with MRI technology or verbal/cognitive testing. This suggests that a new category of brain-related injury problem needs to be diagnosed. Overall, the data suggest “the presence of a previously unknown, but suspected … group of athletes exhibiting neurocognitive deficits that persist over time, but which does not present observable symptoms.” The study’s authors say the findings indicate current on-field tests for concussions may not be sufficient in determining full risks to the brain.

The issue of standards relating to protective helmets also remains an issue. A study published in the Journal of Biomechanical Engineering, “An Investigation of the NOCSAE Linear Impactor Test Method Based on In Vivo Measures of Head Impact Acceleration in American Football,” compared current and new proposed helmet-testing methods in the laboratory to data from real-world play. That on-field data was drawn from the Dartmouth College football team, which wore in-helmet sensors throughout the 2005-2006 season. The study finds that the neck region on laboratory testing equipment needs to be modified and the impact velocities may need to be changed for any new proposed testing standards. Overall, the study suggests that the science of helmet testing is still evolving as it attempts to mirror the experience of players on the field.

Statistics

The National Football League now collects benchmark measures of awareness for each player, which can be used during a game to judge whether he has been concussed.

• From 1931 to 2006, the National Center for Catastrophic Sport Injury Research has reported 1,006 direct and 683 indirect fatalities resulting from participation in all organized football (professional, college, high school, and sandlot) in the US.; the yearly number of indirect fatalities has remained near 9.0 per year

Direct fatality averages^{[citation needed]}

Number/year	Period
18.6	1931-1970
9.5	1971–1990
4.3	1991-2006

• In 2006, with an estimated 1.8 million participants in organized football, the survey reported a relatively high 16 indirect deaths but only one fatality directly attributable to football play (a high school running back who suffered a fatal spinal injury when tackled).
• A 1994 Ball State University survey found that "players in the 1980s suffered serious injuries and underwent operations at twice the rate of those who played in the 1950s or earlier".
• A 2000 University of North Carolina study found that in the period between 1977 and 1998, each year on average 13 athletes had suffered catastrophic injuries (primarily permanent paralysis) through direct result of participation in football; it also found that between 1977 and 1998 "200 football players received a permanent cervical cord injury, and 66 sustained a permanent cerebral injury".
• An estimated 40,000 concussions are suffered every year among high school players.

Impact on post-career life

Injuries sustained by football players are often permanent. Many former football players experience pain, sometimes severe, that lasts for the rest of their lives. Many players require surgery, even multiple surgeries, for injuries experienced years earlier.

Deaths and long-term disability attributed to illegal use of anabolic steroids have become a new factor in this picture, starting in about the 1990s.^{[citation needed]}

Instances of heat-related death, especially during professional practice sessions, have begun receiving press attention in the decade of the 2000s, and led to new standards intended to respond cautiously to possible danger signs that traditionally had been ignored. There is also the prospect^{[citation needed]} that conventional first-aid technique has been in error, and an apparatus to circumvent this: apparently efforts to cool an overheated patient quickly, by wetting a large fraction of the body, are misguided, with the sudden chilling of the skin causing the body to reduce superficial circulation, and making that chilling near the surface ineffective at cooling the core of the body and thus the brain. A device suitable for professional teams has been developed, that provides for rapid cooling of small areas of skin where large blood vessels are near the surface, and is proposed as a means of cooling the blood quickly without evoking the reflex of isolating the body surface from the core.^{[citation needed]}

Certain rules changes have been implemented in an attempt to reduce the number of more serious injuries. An example of this is the illegal "crackback block", when a blocker positioned wide blocks back towards where the ball was snapped. These blocks are infamous for causing severe leg injuries. Another rule recently implemented is that a defender cannot dive or lunge into a quarterback's legs below the knee. The rule has been colloquially referred to as the "Tom Brady" rule, after he was injured from such contact in the New England Patriots' first game of 2008 NFL season. The same injury affected Carson Palmer during the 2005 NFL season.