Fair and his colleagues focused on four types of serious injuries â concussions and damage to the nervous system, bone injuries, torn tissue, and muscle and cartilage injuries. They are the sort that can sideline an athlete for months. And football players, who have the most injuries, can have one after the other, as happened to the son of Terry OâNeil, founder of Practice Like Pros, a group that focuses on making the sport safer for young players.
OâNeilâs son had six major injuries as a quarterback in high school â two concussions, three fractures on his passing hand and a torn knee ligament.
âHe missed half the games in his high school career,â OâNeil said. âYou sit there with your heart in your mouth as a parent watching the games.â
Other athletes suffer for the rest of their lives from injuries in collegiate contact sports. Janet M. Currie, a professor of economics and public affairs at Princetonâs Woodrow Wilson School of Public and International Affairs, says her father, now 80, has had a bad knee ever since he played football in college.
âThatâs 60 years with pain,â she said.
Many more people play sports in high school than in college, so for that reason alone there are more injuries in the younger group. But high school athletes are also more prone to injuries, experts said, because they are not as skilled, they have less experienced coaches and they may not be physically mature.
More high school students play football than any other sport, in part because teams often have 30 to 40 players or even more. There are about a million football players in high school, said Dr. Robert Cantu, a founder of the Chronic Traumatic Encephalopathy Center at Boston University and the medical director of the National Center for Catastrophic Sport Injury Research at the University of North Carolina at Chapel Hill. That number dwindles to 100,000 in college, he said.
âEven if the injury rate is similar, because 10 times as many kids are playing in high school, the total number of injuries is way higher and expensive,â Cantu said. âAnd kids on the high school level donât have good coaching, and some of these kids should never be playing,â he added.
But what is important about the Yale analysis is the focus on the economic cost of these serious injuries, experts said. Already, the cost of football is weighing on some private high schools, Cantu said.
Insurance for football players has become so expensive, he said, that âa number of schools have decided this is a sport they will not continue.â
Kocher, who is also the associate director of the sports medicine division at Boston Childrenâs Hospital, hopes that a focus on the cost of collision sports might lead to some serious funding for injury prevention.
âThere is a lot of lip service about prevention, but not much money,â he said.
There also is not much money for reporting injuries, Cantu said, and what data exists can be hard to collect for studies. The states mandate concussion reporting, he noted, but do not provide funds for it. The sort of data that Fair, the Yale professor, gathered is âthe best thatâs out there, but it is not complete.â
That, though, is all too typical for health data, Currie said.
âOne of the reasons why health research is so backward,â she said, âis that it is very hard to get the data for most health projects.â
Fair said he and other faculty members at Yale would never allow their children or grandchildren to play contact sports. So, he added, âdo we want our students to play?â
But OâNeil said playing football had been such a wonderful experience for his son that he had no regrets, despite his sonâs injuries.
And that point of view, said Roger Noll, a sports economist at Stanford, is what critics are up against. He said he admired Fairâs paper and had sent it to Stanfordâs athletic director. But Noll is not optimistic that even a stark look at injury rates and costs will have much of an effect, especially in football, the most dangerous contact sport.
When he goes to Stanford football games, he said, one of the things he notices is the television production people on the sideline walking around with parabolic microphones.
âIâve asked them why they do that,â he said. âThey are catering to their audience. The audience wants to hear heads crack.â
âTherein lies the problem,â Noll said. âThe reason we are where we are is a kind of bread and circuses aspect to football.â
âItâs a hard row to hoe,â he concluded, âbut maybe, maybe, if we keep doing the research â¦â
An earlier version of this article inaccurately described the number of concussions and hand fractures that the son of Terry O’Neil had as a high school quarterback. He had two concussions and three fractures of his passing hand, not three concussions and two fractures.