Young men die every year playing American football. The risk of that happening, though, is extremely low. According to one data base, during a recent ten year period out of about 2 million football players (excluding pee wee players) in the USA each year, there is an annual average of 14 deaths. About 1/3 of these football deaths occurred as a result of direct trauma mostly to the head and neck. About 2/3 of these football deaths were due to non-trauma causes (such as cardiac arrest, heat exhaustion, and asthma), the largest single cause being previously undetected congenital heart conditions. Unfortunately, preseason routine medical exams would probably have forewarned some but not all those players of their higher risk of mortality from playing the sport.
Serious spinal injuries do occur in football and sometimes result in quadriplegia and a wheelchair dependent life. The risk of this happening is very low. According to a data base covering a 13 year period, out of about 1.2 million yearly participants (high school and college but not middle school), there was a yearly average of 6 neck injuries resulting in quadriplegia. These injuries were several times higher for college players than high school.
High impact collisions typically occur on every play in college football and players are routinely exposed to a high risk for acute and chronic musculoskeletal injuries related to those collisions. Common injuries include lateral ankle sprains, knee ligament and cartilage injuries, shoulder and neck injuries as well as fractures to the ribs, hands, fingers, feet and toes. No studies exist that address the impact of these types of injuries on college players as they age.
Repetitive joint trauma can be a major risk for subsequent osteoarthritis and chronic disability for players in later life. Those familiar with the sport, as well as orthopedic surgeons, have long suspected that the incidence of total joint replacements (knees, hips, and shoulders) is very likely elevated in those that played college or professional football. One study has shown that there is a threefold increase in chronic pain levels and opioid use in former NFL players compared to the general public. There are no good studies of subsequent osteoarthritis, joint replacement, and chronic disability in former college players.
Increased concerns of an aging population of former players about maximizing the disability-free years in later life suggests a very high cost may be imposed on former players if loss of mobility and independent-living results from chronic and debilitating football injuries. The “bigger is better” ethos of college and NFL players (also further discussed below) if not curtailed later in life, may play a significant role in aggravating subsequent osteoarthritis and chronic disability as players grow older.
The “bigger is better” ethos of NFL and college football players also may be linked with potential health issues by heightening the risk of serious cardiovascular disease later in life. This may be limited to larger players, especially lineman but good studies are needed to clarify the risks. In one study, overall, NFL players’ cardiovascular mortality is less than the general U.S. male population. This is may be due to their significant aerobic exercise as well as better access to health care and nutritional education.
This may be a worsening problem in the years ahead given the continuing trend toward “bigger is better”. For example, one study showed that the average NFL lineman weighed 249 lbs. in the 70’s–that figure is now over 300 lbs. for both NFL and college linemen. Later, players may have difficulty losing weight. Excess weight is associated with hypertension, worsening cholesterol, metabolic syndrome and diabetes. These conditions all contribute to arteriosclerosis – hardening and narrowing of all arteries, big and small. This can lead to heart attacks, strokes, vascular dementia, chronic kidney disease and peripheral vascular disease. Good studies of the risks of cardiovascular disease in aging college football players do not exist.
Because of their weight and large neck circumferences, former players may be more likely to have obstructive sleep apnea, a condition that can be more serious than many realize. Studies show a significant prevalence of sleep apnea in former NFL players. This may also be true of former college players. Sleep apnea tends to worsen with aging because throat tissues become less elastic. Sleep apnea robs a person of deep sleep, thus causing daytime fatigue and sleepiness as well as further weight gain. It is associated with heart arrhythmias such as atrial fibrillation and even rarely sudden death from a ventricular arrhythmia such as happened to hall of fame player Reggie White. Good studies of sleep apnea in college players as they age also do not exist.
Medical issues related to neurologic and mental impairments are discussed at another link herein.
Jim Sheahan MD, ND ’71, Retired Family Practice, Monroe, Washington
Member, Players Physicians’ Committee, Independent ND Footballers