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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 longterm 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 flatout 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 three­p­oint 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.


Ed­die Ma­son (left) hud­dles with young play­ers at Mase Train­ing, his foot­ball train­ing fa­cil­ity. Re­gard­ing con­cus­sions, he said, “I think there’s a way we can re­ally head this is­sue off and bring safety back to the game, but it’s go­ing to take time.”

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