A Nurse and Mother on Dialing Back the Risk in Football

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

One Monday afternoon when my son Bryan was a senior in high school I got a call from him. He had hurt his back during football practice and was in so much pain he couldn’t move to get into his car. I rushed over to the field and found him standing, tense and still. When I lifted his shirt to look at his back, I gasped. The entire lumbar area was rounded and swollen out to the size of a grapefruit. At the hospital tests revealed he had a large hematoma, no critical damage done. The first question Bryan had for the doctor—“Can I play on Saturday?”

All week he insisted he could play and I insisted he couldn’t. His arguments never let up—he was quarterback and Saturday’s game was with an archrival. There wasn’t time for the backup quarterback to learn the plays, his team depended on him. Finally I made a bargain. We would go see his physician, whose judgment I trusted, and we would both respect his opinion, whichever way it went.

He played. One of the coaches wrapped his back in layers of padding with an ACE bandage and out he went. It was a brutal game. As determined as he was, the pain still slowed him down and he got tossed around like a rag doll. Finally in the last quarter they took him out.

I was reminded of all this when reading a New York Times editorial this week, “Dying to Play,” about the dangers of football and the growing body of evidence about the devastating long-term consequences of the repeated head trauma that football players endure. It talked about the decision a father, who was a pro football player, made with his son after his son got “his bell rung” in a game. They decided that the son, determined to follow his father into the pros someday, would “keep his mouth shut and his options open” rather than see the physician and wait for the okay to play.

Many parents will have their own version of these stories, the kid who insists on playing in spite of injuries or risk. They hide their injuries, downplay their pain, pop more ibuprofen than you know about. I watched Bryan’s best friend get knocked unconscious in a tackle, spectators standing silenced, watching, waiting for him to move as the coaches and the team doctor bent over him. Finally his legs started moving and people began to clap in relief and support, but I could tell by the erratic movement that he was actually seizing. An ambulance took him off to the hospital and next Saturday he was on the sidelines, impatiently waiting to get back in the game.

All sports carry some risk of injury, but rarely are they life changing or even life threatening. My daughter Kim played soccer and softball and track as well. She headed a ball in soccer and ended up with 10 sutures on her temple; she had a stress fracture in her leg  from track and hobbled around in a walking cast for six weeks. Bryan played baseball, basketball, and ran track as well as playing football. I never worried about them in those sports—not the case for football. From the first game Bryan played in ninth grade to the final game of his senior year, I counted down every game until he was safe.

So why did I “let” him play? That is a complex question. It has to do with culture, expectations, with measuring risk and benefit. And yes, there are benefits. For Bryan, growing up without a father, there were the coaches, all of whom were great role models and one in particular who became a mentor and father figure for him. There was the discipline, the ongoing call to challenge yourself, the teamwork, the leadership skills he developed, the demands of fitness. Yes, these benefits can be had in most team sports, but I hate to admit it, in my experience, to not quite the same degree that I saw with football.

Football is dangerous. Many are raising questions about the ethics of a sport that carries immediate and long-term risks to its players. But it is not going away anytime soon. It has an exalted place in our sports culture. High school boys will continue to dream about being the quarterback who throws the winning pass or the running back who makes that winning touchdown. In the meantime we need to figure out ways to adjust that risk down, if that is possible. As the writer of the Times article points out, the answer doesn’t lie in changing the equipment; there isn’t a helmet now or in the future that will effectively mitigate the physical impact of the game enough to make a difference.

But we can enforce rules about when someone should come out of a game and when they can play again, if ever. Especially at the high school level.

This is a place where school nurses can take the lead. Gather the evidence, draw up a proposed set of guidelines, work with parents and the school athletic director. If they’re not onboard, then get experts to support you and go to the school board. Make sure that every kid who gets their “bell rung” gets seen by an objective physician or NP. The promise, real or imagined, of a future football career should not determine when someone is ready to play again. Develop criteria for mandatory recovery times and for when a kid should not be allowed to play again, ever. They may not be happy with you, and unfortunately many of their parents won’t be as well, but at least they’ll be well enough to let you know.

Nurses in the emergency room or outpatient settings: When a kid comes in with a head injury from football, make sure parents and kids leave with information about follow-up and recovery and the risks of returning to the field too soon.