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 professional sports. Due to the game's popularity, several universities have been criticized for allegedly valuing wins and losses above the educational welfare of the student-athletes. The extent of steroid use also has some controversy attached to it.

Steroids

Recent attitudes toward and awareness of steroid use are also evolving, spurred on by the recent (and highly publicized) baseball steroid scandals. Bill Romanowski, a former player for the San Francisco 49ers, Philadelphia Eagles, Denver Broncos, and Oakland Raiders, recently admitted that he had used steroids while in the National Football League (NFL). Because the use of steroids is an unfair competitive advantage, they are banned by the NFL, which randomly tests all its players for steroids and penalizes those who are caught.

Injuries

Tackles can lead to injuries.

Despite the helmets and heavy padding worn by all players on the field, injuries are common in 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). Note that 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. Similar systems are in place for most major American sports.

The NFL has a roster limit of 53 players per team during the season; 45 of which dress for a game plus an "emergency quarterback" who only plays in limited situations. Players who are injured are frequently among the eight 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

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 research, reported in 2009, which, using phone interviews based on the National Health Interview Survey, 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, neurologist, for the N.F.L. This finding is considered significant as such injuries may potentially affect high school and college players also.

Statistics

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 [2]. While the yearly number of indirect fatalities has remained near 90 per year, the yearly number of direct fatalities has declined from an average of 18.6 per year between 1931-1970, 9.5 per year from 1971–1990, to 4.3 per year from 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).[3]

On the other hand, the number of injuries (per participant) seems to have increased over the years: 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".[4] 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: "200 football players received a permanent cervical cord injury, and 66 sustained a permanent cerebral injury". Concussions are common, with an estimated 40,000 suffered every year among high school players alone [5]. 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.

Impact on post-career life

The average NFL career lasts only 3.8 years. 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.

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 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.

Certain rule 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 effected Carson Palmer during the 2005 NFL season.