In 1905 American Football experienced its first great crisis where many called for its abolition. The previous year there had been 18 deaths and 156 catastrophic injuries at a time when participation figures were small compared to today. This was a time when helmets were not worn by most and those in existence were little more than pieces of leather. Skull fractures and intracranial hemorrhages were the major cause of death and catastrophic injury.
It took Theodore Roosevelt's supportive leadership to save the day and out of meetings of University presidents came not only rules changes to make the sport safer but the formation of the National Collegiate Athletic Association (NCAA) to promote the health and welfare of the student athlete. Thus the "mend it or end it" crisis was settled by rules changes eliminating some of the most injurious practices, forming the NCAA and instating the forward pass to open up the game.
The second major crisis that football encountered occurred in 1968 when there were 38 fatalities due to the skills of the sport. Half of the deaths occurred in the act of tackling or being tackled and all were either from a head injury (30) or cervical spinal cord injury (6). Twenty-six of the deaths were at the high school level, 5 collegiate, 6 sandlot, and 1 professional. During the 1961-1970 time period there were 244 fatalities with cerebral hemorrhage accounting for 73.4 percent and cervical spinal cord injuries 16.4 percent.
Football was once again in a crisis period and something had to be done to reduce the number of fatalities and catastrophic injuries. The football community led by Walter Byers, Executive Director of the NCAA and G. E. Morgan, a consultant of Riddell Helmets and representing the Sporting Goods Manufacturing Association, combined to form the National Operating Committee on Standards for Athletic Equipment (NOCSAE) in 1969. Its major immediate focus was to use the science known at the time to develop standards for equipment to protect first the head and also the neck.
In 1970 work began to establish the first football helmet standard under the direction of V. R. Hodgson at Wayne State University. Three years later in September 1973 the NOCSAE Helmet Impact Standard was published. The standard was set at a level, Severity Index (SI) of < 1500 that two repetitive hits would not result in a skull fracture. Helmets began to be tested to the standard in 1974 and the standard was adopted by the NCAA in 1978 and high schools (NFHSFA) in 1980.
The efficacy of the improved helmets has been borne out by a reduction in fatalities over the ensuing 30 years to an average of 4 per year down from 38, and an 80 percent reduction in intracranial bleeding (subdural hematomas).
Now in the last few years football is facing its third crisis, this one about concussions and sub-concussive blows leading to brain damage that may not be seen for many years, as with most cases of Chronic Traumatic Encephalopathy. Some would argue that taking the helmets off might correct this problem and I would agree it would lessen blows to the head. But at what price?! I would argue that to remove helmets would lead to the skull fracture and subdural hematoma deaths seen in the prior crises of 1905 and 1968.
The father of American Football is Walter Camp who in 1880 modified the rules of rugby to form the game of football. I would argue that removing helmets from football players would reduce the incidence of concussion but would replace it with an epidemic of skull fractures and subdural hematoma deaths.
I believe the answer to reducing the concussion rate in football is to hold officials accountable to the current rules in place since 1972 that state the head (helmet) must not be the initial point of contact in blocking and tackling. There should be no intentional use of the head permitted in these activities.
Furthermore there should be reduced full contact hitting in practice similar to the NFL that allows only 14 full contact practices in 18 during the season and none during the off season. This would reduce concussive and sub-concussive blows to the head by up to 75 percent. Is it not ironic that NFL football players take less head trauma than our college, high school, and our youth?
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Dr. Robert C. Cantu is clinical professor of neurology and neurosurgery at Boston University School of Medicine and co-director of the Center for The Study Of Traumatic Encephalopathy at Boston University Medical Center. In addition, he is a senior advisor to the NFL's Head, Neck and Spine Committee and medical director of the National Center for Catastrophic Sports Injury Research at Chapel Hill, N.C.