On the eve of its biggest spectacle, we are reminded that professional football is experiencing unparalleled popularity. Sunday’s game and its likely 100 million viewers, $3.5 million television ads, and extravagant halftime entertainment will reinforce the idea that football is the premier sport in this country. So what could knock the NFL off its pedestal? Two media features recently make me wonder if concussions in football could ultimately lead to the sport’s demise.

Jonah Lehrer and Dr. Sanjay Gupta suggest that the real danger of concussions might affect the potential stars of tomorrow – our kids. Lerner, in a column appearing in Grantland entitled “The Fragile Teenage Brain,” and Dr. Gupta, in his television special, “Big Hits, Broken Dreams” both demonstrate how serious concussions are for adolescent athletes.

Lehrer presents data from several studies showing long-term effects from multiple concussions among youth athletes. Players who suffered two or more concussions had much higher rates of headaches, dizziness, and sleep disturbances. Players with three or more concussions were more likely to exhibit loss of consciousness and amnesia. And players with multiple concussions had more memory deficits and difficulty processing visual stimuli. This damage can have a practical effect, as kids who suffer multiple concussions have lower average grades. Tweet these statistics.

Lehrer shows how even a minor impact to the brain can initiate a dangerous chemical cascade. The sudden release of neurotransmitters from billions of cells leads to a frenzied process by which the brain tries to restore equilibrium. Dizziness, headaches, sensitivity to bright light, feeling of being in a fog, and many other symptoms after concussions serve as evidence that the player has not yet reached this baseline. Youth athletes take longer to return to baseline than adults. And they are likely much more susceptible to catastrophic brain injuries after second blows to the head because their brains are still developing.

Dr. Gupta details one such injury in a high school running back in Greenville, NC. Jaquan Waller was injured in practice after a forceful tackle and was carried off the field. Since an athletic trainer was not available, a first responder diagnosed him with migraines despite headaches and balance problems. No doctor evaluated him or cleared him to play.

In a game two days later, Waller suffered a seemingly mild blow but quickly lost consciousness. He was rushed to a local hospital but died about 72 hours after the first hit. It was later determined Waller died of second impact syndrome, characterized by massive brain swelling due to successive blows to the head without time for the brain to recover.

Another equally frightening outcome of brain injuries, called chronic traumatic encephalopathy (CTE), has garnered attention recently. This is a degenerative condition of the brain marked by depression, mood alterations, and memory loss that develops with repeated blows to the head. Dr. Gupta notes that football players experience approximately 650 subconcussive blows to the head each year. While CTE can only be diagnosed by autopsy after death, Lehrer points to a 2009 study which showed memory-related diseases were diagnosed among former NFL players at rates 19 times higher than the general population.

Despite increasing media attention and the NFL’s attempts to improve safety, its players largely don’t seem to care. Kris Dielman, who suffered a seizure on a Chargers’ flight home after a game, said after that event that he would risk his health to win a Super Bowl. And Brian Urlacher raised eyebrows recently telling reporters that he would not tell the team’s medical staff if he suffered a concussion. The potential rewards of playing with a concussion might be too great to change their attitudes.

But it is high school players, who likely will never make it to the pros regardless of injury, who are the ones who suffer far more concussions with more lasting consequences. I would argue, though, that there are so many changes parents, coaches, and doctors can make that could help. Athletic trainers at every school, preseason baseline testing, mandatory physician clearance prior to returning to play – these are only starting points. We need more than fancy helmets and tackling education. We need to critically examine every aspect of youth football and find ways to make it safer.

As we watch the Super Bowl Sunday, let’s try to remember all of the young players dreaming of one day playing in this game and pledge to do whatever we can to keep them healthy.

Note: This post will appear in my sports medicine column in the February 1, 2012 issue of The Post and Courier.