Football and Neurologic Decline - It's Not Your Grandfather's Game Anymore
BudWiederman, MD, MA, Evidence eMended Editor, Grand Rounds
Does a report of neurologic outcomes of 1950s high school football players have any
bearing on today's athletes? The short answer is no, but I wouldn't have spent time
examining this prospective cohort study if it wasn't worthwhile.
Don't read this study expecting it to help you make a decision on participation in
high school football for your child or grandchild. However, except for the authors'
puzzling final clause in the abstract of the report, we can learn a great deal from
how these researchers approached this problem.
They utilized data from a prospective cohort of male high school students enrolled
in the Wisconsin Longitudinal Study. They looked specifically at neurologic and mental health testing of almost 4000
men who graduated from high school in 1957, combing high school yearbook information
to determine participation in organized contact sports, including football. They found
no differences in cognition or depression outcomes at age 65 in the men who participated
in high school football, compared to men who did not play football. (As an important
aside, the investigators utilized propensity scoring to try to minimize confounding variables between subjects and controls. This is a
bit like trying to make an observational study perform closer to the reliability of
a prospective randomized trial, but of course it shouldn't be considered a substitute
for such. We're still stuck with all the validity and bias concerns inherent in observational
You don't need to be too much of a student of medicine or statistics to see the problem
with drawing too many conclusions from this study to the present day. Football is
a lot different now than in the 1950s. Players are bigger, stronger, and faster now.
Equipment is better, but that is a 2-edged sword since better protection, particularly
head protection, can lead to more reckless behavior on the field. I tried to find
reliable data on what football equipment might have been used in Wisconsin high schools
in the 1950s but was unsuccessful. It is likely that by the early 1950s the days of
the leather football helmets were long gone, replaced by plastic of varying quality.
Face masks, consisting of a single tube in front of the mouth area, were just coming
into use at professional levels in the mid-1950s.
So, this study is useful largely for establishing a baseline for neuropsychologic
outcomes of high school football players from the 1950s, utilizing a prospective cohort
rather than the more common convenience sample or subjects referred for specialty
neurologic care, for example. It's a roadmap for study design for this particular
outcome question, which is why I was so disappointed to see the end of the last sentence
in the abstract: "... this study provides information on the risk of playing sports
today that have a similar risk of head trauma as high school football played in the
1950s." How are we to know what would be a similar risk?