A Mira Mesa junior varsity high school football player is attended to by training staff after being hit by an Oceanside Pirates player during their game in Oceanside

A Mira Mesa junior varsity high school football player is attended to by training staff after being hit by an Oceanside Pirates player during their game in Oceanside, California September 14, 2012. (Mike Blake, Reuters)

Pop Warner, the largest youth football organization in the United States, in June imposed rules to reduce contact in practice.

Throughout the country, teenage players are taking cognitive function tests before the season to establish a baseline that can later be used as a comparison for those suspected of suffering concussions.

Sometimes it is the players who take a leading role.

"When I get out of the huddle and I go to the line of scrimmage, I'm looking at the defense, I'm looking at where my teammates are, but now I'm also looking out to make sure everybody is alert and responding, especially if they've just been in a big collision," said Presley Miller, the senior starting quarterback at Clark High School in San Antonio, Texas.


In the late 19th century, when American football was an improvised version of rugby, numerous players were badly injured and dozens died playing the game, leading Harvard University President Charles W. Eliot to campaign to ban the sport, according to John J. Miller's 2011 book "The Big Scrum: How Teddy Roosevelt Saved Football."

As president, Roosevelt called the coaches of Harvard, Yale and Princeton universities to the White House in 1905 to promote reforms that would save the sport and ultimately transform it into an industry that generates $9 billion a year for the NFL.

"At a certain level, it's just a re-run of what happened a little more than a century ago," Miller said. "The big difference is that back then players were dying. In 1905 alone, 18 players died from big-time college to the sandlot."

Direct football deaths at all levels peaked at 36 in 1968 and have been reduced to single digits in all but one year since 1978, according to Frederick Mueller, the University of North Carolina expert who publishes an annual survey of catastrophic football injuries.

Since 1984 there have been 164 football brain injuries with "incomplete recovery," which can mean the patients suffer disabilities the rest of their lives, Mueller said. In 2011, there were 13 such brain injuries at the high school level and one at the youth level.

Robert Cantu, a neurosurgeon and Mueller's co-author on the annual injury report, advocates that players under 14 not play tackle football.


Watching his son's peewee football team play five years ago, Joe Ackerson was shocked to see young players suffer concussions without the brain injuries being identified.

Instead the boys were allowed to re-enter the game.

"Here were these young kids, ages 10 and 11, getting concussions and it not being recognized as such," said Ackerson, a neuropsychologist who treats brain-injury patients in Birmingham, Alabama. "There was a severe knowledge deficit."

Since then, with the guidance of a task force that Ackerson led, the effort to combat concussions in youth and high school sports has gained prominence in Alabama.

Ackerson also worked with educators and coaches at the Birmingham area's Hoover High School, where his now 16-year-old son plays defensive end, to develop a program for managing concussions and reducing their likelihood.

Hoover, a perennial power, has vowed to stop athletes from concealing their symptoms, no matter if it is a star who stands to lead the team to yet another state championship.

"Even if they're lying through their teeth, we've got a good line on it," said Brandon Sheppard, the school's head athletic trainer.

In Texas, 2011 legislation and increased public awareness have chipped away at old attitudes about concussions, but there are concerns about enforcement.

"I know a lot of coaches who won't go along with it," said Dave Burton, an athletic trainer in Dallas who has worked in pro sports and public schools. "They would rather have a key player at 75 percent than a backup at 100 percent."

(Additional reporting by Tom Bassing in Alabama, Jim Forsyth and Marice Richter in Texas and Marty Graham in California; Writing by Daniel Trotta; Editing by Claudia Parsons and Bill Trott)