On April 10, 2005, Macon football star Al Lucas took a hit that he would never recover from.
Just minutes into an Arena Football League game for the Los Angeles Avengers, the youngest son of Georgia State Senator David Lucas and Macon-Bibb County Commissioner Elaine Lucas collided with another player.
Shortly after, he was pronounced dead.
“It’s the worst possible thing that you could ever have happen,” Elaine said. “So, for a while there, you’re just kind of in a state of shock. And you realize that there’s always that possibility when someone is involved in sports.”
Lucas’s death was a freak accident. And it didn’t diminish his family’s love of football.
But the tragedy serves as a reminder that football, like all contact sports, poses a great risk to its athletes.
And the dangers could be greatest for young athletes, whose brains and bodies are still developing, researchers say.
In recent years, new research on traumatic brain injuries — concussions being the most common example — has changed attitudes toward America’s most-watched sport, especially regarding its impact on young players, according to Gallup. High school football participation is at its lowest point in decades.
Tackle football has been one of the most popular high school sports for decades, with over a million participants across the country each year. But as fears of head injuries grow, some football fans wonder if they can save the sport by making it safer.
In the past 10 years, 11-player high school tackle football participation has fallen 7.1 percent, from 1,113,062 participants in the 2008-2009 academic year to 1,039,079 participants in 2017-2018.
Of the nearly 1.4 million estimated high school sports-related injuries in the 2017-2018 academic year, over 463,000 were sustained while playing football — more than in any other sport tracked in the most recent High School Sports-Related Injury Surveillance Study. Concussions accounted for about a fifth of those injuries.
The health risks
A growing body of research suggests brain injuries can have both short- and long-term effects on athletes’ health. And the symptoms can be wide-ranging, said Dr. Joseph Trasmonte, pediatric neurologist for Navicent Health.
In the short term, Trasmonte’s patients might experience dizziness, confusion or slowed thinking in mild cases. More severe injuries can cause vomiting, amnesia or behavioral changes, he said.
Most patients recover within the first one to three months after sustaining a mild traumatic brain injury, Trasmonte said. About 20 to 30 percent, however, experience long-term symptoms, such as cognitive impairment, memory difficulties, shortened attention span, headaches, seizures or even neurological disorders, like chronic traumatic encephalopathy, which causes the brain to gradually deteriorate and can lead to depression, substance abuse or suicidal thoughts, according to Mayo Clinic.
Dozens of studies have investigated possible long-term impacts of sport-related concussions. More research is needed, though, Trasmonte said.
The neurologist wonders what impact the severity and quantity of head injuries might have on athletes’ long-term health. He also hopes to see more research on which groups might be particularly susceptible to lasting neurological symptoms.
There’s no magic number of concussions that determines when a young athlete should consider giving up the sport, Trasmonte said. But athletes who return to play before they’ve fully healed are more likely to sustain additional head injuries in the future, because their reaction time and coordination might still be impaired, he added.
“The most important advice is remove from play after a suspected concussion, evaluate and, if a concussion diagnosis is reached, observe closely and only return to play when completely free or completely recovered from the concussion,” Trasmonte said.
‘Health and safety comes first’
Tripp Youngblood knows how frustrating the concussion recovery process can be. As head athletic trainer for Peach County High School, he works with student athletes from the moment they injure themselves until the moment they’re healed.
“I want these kids to participate and I want them to play, but my role here is to make sure that their health and safety comes first,” Youngblood said.
The athletic trainer acts as the eyes and ears on the field during practices and games, watching closely for signs of injury. If Youngblood notices anything strange, he immediately pulls the player out of the game and conducts a sideline assessment.
Youngblood will check the student’s pupil dilation, test his or her memory and check for common concussion symptoms. If the injury seems serious, players are taken to the hospital. In less severe cases, they sit out for the rest of the game and then visit Youngblood the next day for a more thorough evaluation.
Then, the recovery process begins.
Once symptoms subside, students gradually work their way up from a 15-minute bike ride to a full-contact practice. If at any point in the process their symptoms return, players start back at square one.
Rehabilitation can take anywhere from six days to several months, Youngblood said. And the younger the athletes are, he said, the longer it seems to take them to bounce back.
Youngblood has already treated about 10 students for concussions this school year — some football players and some basketball players. Youngblood said he and his colleagues are more hesitant to let athletes return to the sport after a head injury than they were when he first started training six years ago.
“Our protocols for concussions have changed drastically,” Youngblood said. “The kind of things that we look for and the amount that you kind of look out for different symptoms of things has greatly gone up with the level of interest and kind of the spotlight that’s been put on head injuries recently.”
When symptoms don’t immediately subside, players often grow frustrated, Youngblood said. But he doesn’t just treat his athletes’ physical ailments. The athletic trainer also acts as a therapist, listening when they feel discouraged and helping them to celebrate small strides.
Sometimes staying on the bike for an extra five minutes can be a big deal.
“We’re just constantly trying to tell them, ‘Hey, look, you’re improving. Just kind of keep focused on the goal,’” Youngblood said. “But at the same time, you have to make them realize the importance of making sure that they are fully healed before we return them to play. And so there’s a fine line there.”
Youngblood has seen how grave the consequences can be when a player sustains a head injury.
A Pike County player died from cardiac arrest after sustaining a traumatic brain injury during a football game against Peach County High School this past fall.
The chances of a fatal football injury are incredibly rare. Of the 4.2 million youth, high school and college football players in 2017, only four sustained fatal injuries directly related to the sport, according to the National Center for Catastrophic Sport Injury Research.
“We saw pretty much the rarest of rarest situations this year, and that is the ultimate concern,” Youngblood said.
The tragic accident reminded Youngblood that head injuries should not be taken likely. Though most injuries are non-fatal, even mild concussions can impact players off the field for days or weeks after the fact.
“The brain, if it’s injured, just like any other part of your body, needs rest,” Youngblood said. “And if a kid’s in a classroom and reading and trying to concentrate on school work, that’s obviously not allowing the brain to rest, and it can cause the symptoms to increase.”
‘There’s risk in anything’
Concussion protocols have changed drastically in Youngblood’s six years as an athletic trainer. In high school athletics, he said, there’s less head-to-head contact, more training for coaches and a closer attention to warning signs during practices and games.
Every state in the U.S. has passed laws to protect youth athletes from sports-related concussions.
Georgia adopted its own Return to Play Act in 2013, which requires schools to inform parents about the risk of concussion and remove injured athletes from play until they receive medical clearance.
The rules are more lax for youth leagues, but Athletics Coordinator for the Macon-Bibb County Recreation Department Brittni Fletcher goes beyond the state-mandated safety requirements to keep her players healthy.
All equipment is up to date and regularly inspected to ensure that young players are protected, Fletcher said. Her coaches are required to complete concussion and first aid trainings through USA Football or the National Alliance for Youth Sports, as well.
This past season, Fletcher said, the league added concussion information to its registration forms, so that parents could also be on the lookout for symptoms. If players injure themselves, they can’t play again without a doctor’s note.
In spite of the risks, Fletcher doesn’t think kids should stop playing tackle football. If anything, she thinks the number of youth tackle football players in her league has increased in recent years because of its strict safety regulations.
When parents tell her they’re afraid, she asks them to think about why.
“There’s risk in anything,” Fletcher said. “There’s risk when we get in our car to drive home. There’s risk when we eat a meal. There’s risk. That’s a part of life.”
If parents think the benefits outweigh the hazards, she advises them to let their children play, as long as they educate themselves on how to avoid injuries.
“Don’t let your personal fear hinder your child,” Fletcher tells parents.
Other youth leagues have abandoned tackle football altogether in recent years.
“You cannot teach a child to tackle safely,” said Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation.
After suffering long-term symptoms from brain injuries sustained as a college football player and professional wrestler, Nowinski launched the Flag Football Under 14 campaign, hoping to protect young athletes from the lifelong consequences of head injuries. More than a dozen prominent players and coaches, including John Madden and Drew Brees, have signed on.
Children face heightened risks, because their brains aren’t fully developed, Nowinski said.
“If I was talking to a parent about choosing to put their child in tackle football at five, I would ask them, ‘Do you hit your child in the head?’ And if they said no, then I would say, ‘Then don’t let anybody else hit your child in the head, either,’” he said.
Nowinski doesn’t think that kids should stop playing football. He hopes his own daughter will play sports one day. He just doesn’t think tackle is appropriate for children under 14.
“I’d say the risk isn’t worth it,” Nowinski said. “They can still pick up football later, and they’ll thank you for it in the future.”
Elaine Lucas knows the risks all too well.
But if she were to go back in time, she’d still let her son play football.
Lucas was born into football, Elaine said. He was eager to follow in the footsteps of his grandfather, father and older brothers from the time he was seven or eight.
“You can’t ever predict when something tragic is gonna happen,” Elaine said. “But you can’t live your life with this idea that, ‘Oh my goodness, I’m not gonna be involved in stuff because something might happen.’ You just get into it, you try to make it as safe as possible, you try to enjoy it.”
Information from The Telegraph archives was used in this report.
Samantha Max is a Report for America corps member and reports for The Telegraph with support from the News/CoLab at Arizona State University. Follow her on Facebook at https://www.facebook.com/smax1996 and on Twitter @samanthaellimax. You can also join her Facebook group. Learn more about Report for America at www.reportforamerica.org.