As nearly 17,000 high school football players in Massachusetts prepare for a new season, concerns over the safety of the sport and the long-term impact of head injuries continue to mount. Recent research highlights the risks associated with repeated head trauma, raising questions about the adequacy of current safety measures in the state’s high school football programs.

A recent national study focusing on former NFL players found chronic traumatic encephalopathy (CTE), a progressive brain disease linked to repeated head impacts, confirmed in 215 out of 235 brains examined postmortem. The study, involving institutions such as Mass General Brigham and Boston University, concluded that at least a quarter of NFL players who died between 2016 and 2021 showed evidence of CTE. Among those affected was Aaron Hernandez, former New England Patriot, whose brain displayed stage 3 CTE when he died at age 27.

Researchers emphasize that exposure to head trauma often begins well before the professional level, with players accumulating hits during youth, high school, and college careers. Dr. Daniel Daneshvar, lead author of the study, noted that these early impacts significantly increase the risk of developing CTE.

Football is not unique in this regard. Studies have found similar brain-related damage in young athletes participating in other contact sports, including hockey and soccer, where even non-concussive impacts, such as heading a soccer ball, can cause harm. Growing awareness of these dangers may partly explain a 17 percent decline in high school football participation in Massachusetts over the past 15 years, a drop notably steeper than the 7 percent decrease nationwide.

High school football in Massachusetts falls under the jurisdiction of the Massachusetts Interscholastic Athletic Association (MIAA), which enforces safety guidelines but stops short of mandates in many areas. The MIAA requires that initial football practices focus on conditioning and limited contact, with full-contact practice restricted to 60 minutes per week during the season. However, these rules lag behind efforts by institutions like the Ivy League, which banned full-contact practices entirely in 2010.

While the MIAA mandates that a licensed medical professional—such as a physician, athletic trainer, or EMT—be present at games, no such requirement exists for practices. Coaches and trainers often manage injuries without immediate medical evaluation, a gap highlighted by multiple incidents such as the recent traumatic brain injury sustained by Sharon High School player Rohan Shukla in late 2024. Investigations revealed that school nurses had repeatedly requested full-time athletic trainers, citing concerns over athletes returning to play without proper medical clearance.

Equipment advances, such as helmet covers known as guardian caps, offer additional protection by absorbing some impact forces. Though the NFL mandates these caps during practice for certain positions, the MIAA does not require their use in high school football. A handful of schools in wealthier communities have adopted guardian caps, but widespread usage remains limited.

Given the inherent risks of football, experts and medical professionals stress the need for more consistent protective policies and resources at the high school level. Dr. Lee Mancini, chair of the MIAA Sports Medicine committee, has advocated for a full-time athletic trainer in every public high school in the state. Meanwhile, coaches report difficulty convincing players, particularly linemen, to wear protective equipment voluntarily.

While no strategy can eliminate the risks associated with a contact sport like football, there is a growing consensus that stronger safety protocols and greater investment in medical support are essential. As Massachusetts maintains its strong football tradition, the challenge lies in ensuring the well-being of its young athletes through more proactive and uniform measures.