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In today’s American society, football is no longer just a sport, but a

lifestyle. In a multi-billion dollar industry, there is increasing pressure

on athletes of all levels and ages to perform and reach their highest

potential. With the media glorifying the National Football League (NFL),

athletes strive and sacrifice to reach what they perceive as excellence,

sometimes sacrificing themselves physically. Varying factors, from

intrinsic and extrinsic motivation to goal setting can effect an athlete’s

decision to participate and continue in this risky sport. Athletes

participating in contact sports, most notably football, take hard hits

again and again but current evidence suggests damage of the brain

caused by these events is having serious, even fatal consequences.

Factors affecting athlete’s decisions to underreport and not report

head injuries are leading to short term and long term consequences,

and inevitably changes in the NFL. With the increased attention and

awareness of these injuries, there is a need to take a look at why

athletes continue to play after sustained head injury leading to

increased risk of permanent and life threatening brain damage.

Andre Waters, an NFL defensive back for nearly ten years, was no

stranger to taking hard hits. Throughout his football career he received

multiple concussions but continued to play until his retirement in 1995.

After his football career, Waters continued on as a football coach at

several colleges and universities, including Morgan State University

and The University of South Florida until his unexpected suicide in

November of 2006. His suicide remained a mystery until Chris

Nowinski, “a former Harvard football player and professional wrestler

whose repeated concussions ended his career” learned of Water’s

story (Schwarz, 2007). With permission from Water’s family, Nowinski

sent the remains of Andre Water’s brain to be examined by Pittsburgh

based neuropathologist Dr. Bennet Omalu. After examining the

remains of Mr. Water’s brain, Dr. Omalu concluded he had “sustained

brain damage from playing football [which] led to his depression and

ultimate death” (Schwarz, 2007). Dr. Omalu also concluded that “Mr.

Water’s brain tissue had degenerated into that of an 85-year-old man

with similar characteristics as those of early-stage Alzheimer’s

victims…and he believed that the damage was either caused or

drastically expedited by successive concussions Mr. Waters had

sustained playing football” (Schwarz, 2007). This discovery adds to the

growing scientific debate over whether athletes who have sustained

multiple concussions (whether they realize it or not) are “at a

heightened risk of depression, dementia, and suicide as early as

midlife” (Schwarz, 2007). With the increased awareness,

understanding and education of the long-term (and sometimes fatal)

effects of head injuries, it is vital to understand why athletes continue

to participate in football when there are such great risks.

Interest in football is developed at a young age. It is very common for

families to gather together on weekends in the fall to participate in

America’s ‘favorite pastime’; football. Whether at the Pop Warner level

or the NFL, the culture surrounding the sport is engrained in many

American families. From an early age, boys watch the game with their

fathers and relish in the excitement, athleticism and fame they might

one day achieve through the sport. According to Cote, excellence in

football can be reached through four stages (sampling years,

specializing years, investment years and maintenance years) with

social support (Durand-Bush & Samela 2002). Many times to reach

“excellence” boys work through these stages ignoring injuries and

setbacks in an effort to reach their goals. Although boys see the perks

of a future in football, many negative aspects of the game are

dismissed and ignored. Raised in a culture where football is presented

in the spotlight, many of these children participate in the sport starting

at a young age with hopes to one day reap the benefits society has

deemed upon football players and teams. However, most are unaware

of the price many of these gifted players pay.

As with most sports, development in football begins at a young age in

Pop Warner Youth Football Programs. “Over 240,000 youths

participated in Pop Warner-sanctioned football programs in 2009, and

those numbers are continuing to grow” (“Pop Warner Little Scholars”,

2010). At this basic entry level for football, players are able to

“sample” the sport and see if it is something they would like to pursue.

The sampling years represent “a period in which the athlete engages

in various sports, games, and physical activities mainly for their

pleasure and social aspects” (Durand-Bush & Samela, 2002). The Pop

Warner league gives young athletes “experiences that build their

appreciation for and understanding of leadership, teamwork, and

discipline”, unarguably valuable skills for the future, not only in sport,

but life as well. At this level, there is an emphasis on character building

through team achievement: “We don't try to build stars. We don't want

to over-inflate a young ego, nor do we want to risk injuring the self-

esteem of a young person. Whether our kids have good days or bad,

they are still an integral part of our team…and always will be” (“Pop

Warner Little Scholars”, 2010). A “safety first” view is also emphasized

in Pop Warner football, where athletes compete with other kids of

similar age and size in order to reduce injuries. Although injuries, on

average, are not nearly as severe compared to more advanced football

athletes, they do still occur. At the entry level, boys are taught the

foundations of football, in character and skill. The basic mechanisms

are taught, and this time period is used for athletes (and their parents)

to decide if it is something worth pursuing and advancing to the next


Athletes who participate in high school football unarguably take the

next step in their athletic careers by “specializing” in football,

according to Cote. This time period represents “a period in which

athletes invest more time and effort into the practice of a few
preferred sports” (Durand-Bush & Samela, 2002). With this more

advanced stage in sport come more expectations and pressure from

the athlete himself, his school, his team, and support system. These

pressures can range from making the varsity team, to achieving a

college scholarship. With these added pressures and expectations,

what was once fun and playtime in Pop Warner becomes nerve-

wracking (yet still exciting) at the high school level. With more on the

line, athletes are more likely to sustain head injuries and forgo

reporting them or receiving treatment. An estimated “15% of high

school football players sustain a concussion each season” and the

“most common reason for a concussion not being reported was that

the injured player did not think it was serious enough to warrant

medical attention” and motivation to not be withheld from the game

(McCrea). It is at this level where many players decide to continue and

strive to reach excellence (continuing to college athletics) or end their

football careers. With the decision to specialize in football, athletes

take on significant risks of injury, many of which they remain unaware

due to a lack of knowledge among players, coaches and parents

(McCrea). In an effort to reach the next stage in attaining excellence,

many players ignore head injuries that may affect them in the long


It is undeniable the excitement, spirit, and school pride of college

football is contagious. Although few athletes reach this level of

performance, those that do make many sacrifices. This stage is

referred to as the “investment years”, which are “characterized by a

period in which the athlete is generally focused on one sport” and

makes sacrifices to pursue excellence in that sport (Durand-Bush &

Samela, 2002). At this level, athletes experience more “challenges and

drawbacks” and “expectations from coaches, sport federations, [fans],

family and friends were high” (Durand-Bush & Samela, 2002). Athletes

feel increased pressure and know the sacrifices they are making to

reach that next level of performance. With many athletes vying for a

starting position and playing time, underreporting of sustained head

injuries, again, becomes problematic (statistics will be discussed later).

With 32 teams across the United States, the National Football League

(NFL) represents achievement of “excellence” in football. According to

Cote, this stage in the athlete’s career represents the “maintenance

years”, which is the stage “athletes enter once they reach the pinnacle

of their sport” (Durand-Bush & Samela, 2002). During this stage,

“athletes continue to train and compete in their sport of excellence in

order to not only maintain but also improve their performance”

(Durand-Bush & Samela, 2002). The NFL is not only a sports

phenomena, but a business that brings in billions, with professional

players often earning millions of dollars and fans participating in

“fantasy leagues”, where typical football fans can manage their own

“fantasy” team. In fact, “an entire industry has developed to provide

services to fantasy football players such as league hosting, expert

information and analysis, and mobile means of checking fantasy scores

on game days” (Holleman, 2006). With an entire industry revolving

around them, NFL players face even more pressure to perform. These

high profile athletes are stronger, faster and much heavier than the

average player, and they take many hits and make many tackles

throughout their career. To reach this level of excellence in football,

players’ bodies, and more importantly their brains sustain years of

trauma and impact, which unfortunately (as more research is

demonstrating) is causing negative consequences for their post-

football life.

Despite awareness, regulations and the use of protective equipment,

head injuries, most notably concussions, remain common in football. A

concussion is defined as a “clinical syndrome characterized by

immediate and transient posttraumatic impairment of neural functions,

such as an alteration of consciousness, disturbance of vision,

equilibrium, ect…due to brain stem involvement” (Guskiewicz, 2000).

Due to this subjective definition, it can be difficult to diagnose, and

effectively treat a concussion and “clinicians must rely on a subjective

account of the symptoms reported by an anxious athlete, rather than

sound, objective data” (Guskiewicz, 2000). Athletes who come out of

practice or a game with a potential head injury often rush or fail to

report experienced symptoms in an effort to get back to practice or

back into the game. Because coaches, athletic trainers, and physicians

must rely on the athlete’s reported symptoms, “it is often difficult to

determine the severity of the initial injury and to make a confident

return-to-play decision” (Guskiewicz, 2000). The decision to return-to-

play is crucial to avoid any further damage to the brain. When players

return-to-play after underreporting or failing to report symptoms they

become at risk for second impact syndrome, “which involves fatal

brain swelling after a second concussion” (Guskiewicz, 2000). In a

study of incidences of concussions, Guskiewicz, et al. found that

“players who sustained one concussion in a season were three times

more likely to sustain a second concussion in the same season”

compared with uninjured players (Guskiewicz, 2000). This significant

statistic “might be attributed to the increased exposure (athletes

playing both offense and defense) often seen at the high school and

collegiate levels” and the skill level of players (Guskiewicz, 2000).

Common “belief is that the motivation to participate in competitive,

aggressive sports has led to bigger, faster, and stronger athletes, and

has consequently increased the velocity of collisions and the severity

of head injuries in football” (Guskiewicz, 2000).Many football athletes

spend years pursuing excellence in their sport, so it is understandable

that most would not want to end their careers because of concussions,

but with these overwhelming statistics it is important to recognize all

factors that contribute to athletes’ continued participation in football

after receiving head injuries.

American football is a sport viewed as many for the most physically tough, with

player repeatedly hitting one another at full speed with the aim to take the player with the

ball to the ground as fast as possible. Naturally, to play a sport such as this one has to be

mentally tough as well. However mental toughness is much harder to define than

physical toughness. Much research has been conducted by sports psychologists to

uncover the characteristics that best describe mental toughness; however there is yet to be

one universally accepted definition. According to Clough, Earle and Sewell (2002

(mental toughness, optimism)) mentally tough people have “a high sense of self-belief

and an unshakeable faith that they control their own destiny, these individuals can remain

relatively unaffected by competition and adversity.” However according to Graham

Jones, “mental toughness represents the ability of a person to cope with the demands of

training and competition, increased determination, focus, confidence, and maintaining

control under pressure.” Mental toughness is one of the most commonly used terms in

sports psychology but also one of the least understood. It is a very central part to success

in the athletic environment and many other environments such as academic, business etc.

Similar to people who work a professional job 9-5 5 days a week in an office (e.g.

doctor’s, lawyers, businessmen etc) players in the NFL are professionals and it is their

job to show up to work and perform. Doctors and lawyers avoid missing work as best as

they can, because it is what supports their families and lifestyles- however their work

environment is much less dangerous than that of an NFL player. But the principle behind

not wanting to miss work is the same in both scenarios. Professional football players
returning to play after sustaining an injury is a highly debated topic these days in the

NFL, and there is much speculation as to why an athlete might be motivated to play when

injured. In an article published in Research Quarterly for Exercise and Sport in 2007

examined why collegiate athletes play through pain during competitions. Jennifer

Waldron and her colleagues found that the athletes in the survey played through pain

because they felt it was necessary to succeed. There were a number of issues surrounding

the self, most didn’t want to sit out or wanted to continue improving their skills. Some

played through pain due to the nature of the sport, or because it was an important time

during the season, for example playoffs. Some also reported that during competition the

pain was lessened or not present at all. But the trouble in exploring these head injuries is

that it isn’t something that one can specifically detect to be a painful injury. A

concussion exhibits the majority of symptoms immediately after it occurs, dizziness,

nausea, difficulty balancing etc. The risk in playing with a concussion is that a second

impact to the head could cause a large increase in intracranial pressure and can cause the

brain to herniate. The brainstem can then fail within five minutes leading to certain

death. Many people wonder why with such a large risk associated with returning to play

after a concussion in a high-velocity contact sport such as football why athletes insist on

taking this risk.

Mental toughness is attributed to many parts of physical toughness as well and it

particularly relevant to our discussion of sustained head injury with the issue of returning

to play after a concussion.


Professional football players are under a great deal of pressure to perform not only
from themselves and fans but also from the organizations that they play for. The pressure

to win is demonstrated every season with roster moves and coaching changes in the off-

season. While having a winning team was a large part of high school and collegiate

sports, the management was not quite as ruthless as they are in professional sports to

create a winning team. This pressure manifests itself in the players as extrinsic

motivation. As mentioned earlier, playing football is their career, much like many

students leave school to become doctors and lawyers, collegiate football players hope to

leave school to secure a job in the NFL. The “need achievement theory” is a

psychological theory examining the construction of motivation in players. The theory is

divided into two personality factors: motivate to achieve success and motivate to avoid

failure. These two factors are what drive players perform every day, but they’re also a

large part of what drives players to return to play after an injury. The motivation to avoid