On-field safety measures increase dramatically as game adapts to new concerns and survey data showing that fewer parents and players are willing to accept the risk of potential injury.
Tackle football remains one of the most popular sports in America, but participation in high school football in South Dakota and across the United States is falling steadily as the risk of brain injuries from the sport becomes clearer.
Participation in 11-player boys football in South Dakota fell by 5.2% over the past three years, and dropped by 16.6% over the past decade, according to data from the National Federation of State High School Associations, which has done annual participation surveys for more than 25 years.
Participation in nine-player football, played in smaller, mostly rural districts, fell by 3.7% across the nation over the past 10 years, according to the survey.
The decreases came as student enrollment in grades nine through 12 in South Dakota — the grades that play high school football — was essentially flat during that 10-year time frame at about 43,000 students.
Nationally, participation in boys 11-player high school football — the sport with the highest participation among all sports — fell by 5.2% last year to about 1.1 million players.
Recent studies have shown that from 5% to 10% of youth football players will suffer a concussion — defined as a “mild traumatic brain injury” — at some point during a full season. With about 1 million athletes playing high school football in the U.S. annually, that means between 50,000 and 100,000 teens will suffer a concussion each year, not including those at youth and junior high levels.
Supporters of football — including players, parents, coaches and association officials — see the sport as one that builds character, focuses on teamwork and is outright fun to play and watch. They also note that fear of injury is only one element of a complex decision that high school athletes make in terms of whether to play football.
Furthermore, in South Dakota specifically, population trends have shown reduced enrollment in many rural schools and decreased opportunities for play.
“I think it’s more than just looking at the number and saying, ‘Well, over this period of time we’re down all these kids participating and that it’s because we’re concerned about safety,’” said John Krogstrand, assistant director of the South Dakota High School Activities Association. “I think it’s much more than that.”
South Dakota had 3,756 participants in 11-player boys football in 68 schools in 2009 and only 3,133 in 66 schools last year, according to the national survey. For comparison, the state had 3,576 participants in boys basketball last year and 697 in boys soccer.
Krogstrand noted that all school districts have implemented new safety guidelines, improved equipment and instituted concussion protocols to prevent head injuries and treat them better. He also said some of the drop in participation is likely due to falling high school enrollment in the early 2000s, which led some schools to end football programs.
He noted as well that much of the enrollment growth in the state has been in Sioux Falls and its suburbs, where opportunities to play are limited to one team at each school no matter how big the school gets.
But with mounting evidence of significant long-term impacts of football-related injuries, particularly those to the head and brain, the survey data reveal that parents and young players themselves are increasingly staying away from the sport.
In South Dakota, the reduction in participation has led some districts, including many in rural areas, to keep the sport alive by entering into co-op agreements in which nearby schools combine players to form a single team. Other schools with enrollment or participation decreases have moved from 11-player to nine-player football, making it easier to field a team.
Most parents whose children play football are aware of the risks, yet many say they believe the game has gotten safer as awareness of concussions risks has risen.
Dale Uttecht of Sioux Falls traveled to Rapid City on a recent Friday night to watch his son, Joe, play football for Sioux Falls Washington against Rapid City Stevens. As he bought four cups of hot chocolate on a rainy September night, Uttecht said he sometimes holds his breath while watching games played by Joe or his older brother Logan, who plays wide receiver for Augustana University.
“All the players are bigger, faster and stronger, so any injuries are going to be worse,” he said.
Uttecht said the increased recognition of the risks of head injuries in football has led to changes that he believes have made the game safer, including at Washington High, where a certified trainer is present for all practices and games.
“You always have concerns, but I hear about concussions in soccer and basketball, too,” Uttecht said. “It’s really their decision if they want to play or not.”
Strong link between concussions and football
Numerous research studies have shown a strong correlation between concussions and contact sports, particularly football. A concussion is a mild traumatic brain injury in which the head and brain shake violently, often causing confusion, headaches, dizziness, nausea or vomiting, and in severe cases, loss of consciousness.
Most people with a concussion recover fully with time, and research is inconclusive whether a single concussion will lead to long-term brain impairment. Evidence shows, however, that the longer a person plays football and the more hits to the head they take, the chance for long-range impairment or illness increases.
Recent research has shown that football, hockey and rugby are the sports most likely to lead to concussions, and that 9.6% of all injuries in youth football are concussions, 4% in high school football are concussions and 8% in collegiate football are concussions.
Children and teens are more susceptible to concussions and take longer to recover than adults, according to physicians with Sanford Health in Sioux Falls.
Thayne Munce, associate director of the Sanford Sports Science Institute, is an expert on brain injuries related to football and has led research efforts into on-field head injuries, specifically at the middle-school level.
Munce used sensors in the helmets of seventh and eighth grade football players to measure the number and severity of head hits during games. His research showed that players in those grades received fewer head impacts than high school players, mainly due to fewer practices and games being held. But he also found that the severity of head impacts in the lower grades was equal to those at the high school level.
“Their head-impact severity, basically what happens to a head after an impact, is nearly identical to high school level,” Munce said. “Even though they’re smaller athletes and not running as fast, their impact severity is just as high.”
Munce said research does not appear to indicate that athletes who only play football through high school will have long-range brain or neurological implications.
“There isn’t enough strong evidence that suggests playing youth football or through the high school level has a significant risk of long-term negative brain health consequence,” Munce said.
A growing concern for athletes in contact sports, particularly football, is the finding that chronic traumatic encephalopathy, or CTE, has been diagnosed in people who have had repeated jolts or hits to the head, including but not limited to repeated concussions.
CTE has no treatment or cure and can lead to mood disorders, memory loss, behavior problems and dramatic personality changes. In CTE, a destructive protein spreads through the brain, killing brain cells along the way.
New research in 2018 further heightened concerns about repeated brain injuries and the connection to a condition called Lewy body disease, which can increase the risk of dementia, Parkinson’s disease and Alzheimer’s disease.
Krogstrand noted that South Dakota coaches, athletic directors and referees are required to complete an annual online course about concussion prevention, identification and treatment. Other new rules limit the amount of contact players can have in practices.
Krogstrand noted that in a 2019 ranking of high school safety policies by the Korey Stringer Institute, South Dakota ranked ninth-best among the 50 states.
Schools regroup as interest wanes
Quinton Cermak, superintendent of the Highmore-Harrold School District in central South Dakota, saw the Highmore-Harrold schools undergo a significant drop-off in players in recent years. Cermak also coaches the Miller/Highmore-Harrold football team that includes his son.
In 2014, Cermak was coach of the nine-man Highmore-Harrold football team and said that just before the 2015 season, several students dropped out of football, leaving him with less than nine players.
“It was a blend of kind of everything; there really wasn’t a one-size-fits-all reason, but there are some kids concerned about playing and being injured,” he said.
Cermak arranged a co-op agreement with the Miller schools, and since then his roster has grown to about 32 players.
This season, half a dozen players on Cermak’s team have suffered significant injuries, including a torn knee ligament, a broken collarbone and three concussions.
Cermak recalled an incident a few years ago when a football player had a severe concussion that required him to miss a week of school.
“He spent a week in his basement, with no TV, phone, or computer; he had such an adverse reaction to light that would intensify his headache, so he had to sit in his basement and just heal,” Cermak recalls. “He was suffering the effects a month or two later.”
But those injuries, and a concussion suffered by his son, have not dimmed Cermak’s view of football as a way to build character and teach student to work hard or “grind” to find success on the field and in life.
Brian Allmendinger, a football coach formerly in Gregory and now in Milbank, said he has sometimes missed a hard hit on a player but was approached by a referee who suggested the player be taken out.
“If a kid is even suspected of having a concussion, coaches and even officials can pull a kid out,” he said.
One youth football league in South Dakota is anticipating strong participation in the future, in part because of a greater focus on safety and improved communication with parents.
Lee Kruse, a director of the Black Hills Youth Football League, said participation has risen from 850 players in 2015 to 902 this year. The league is independent of the school system and features players in pads in tackle-football games in leagues ranging from first through seventh grades.
Kruse said increased information on concussions led the league to drop teams to six players and ban special-teams plays that heighten collisions.
“We go over the top on safety, and play for the right reasons, because it’s about development and not touchdowns at this age,” Kruse said.