Fourth Down and Inches: Concussions and Football's Make-or-Break Moment

When the 1905 football season ended, nineteen players were dead and countless others were critically injured. The public was outraged. The game had reached a make-or-break moment—fourth down and inches. Coaches, players, fans, and even the president of the United States had one last chance: change football or leave the field.

Football's defenders managed to move the chains. Rule changes and reforms after 1905 saved the game and cleared the way for it to become America's most popular sport. But they didn't fix everything.

Today, football faces a new injury crisis as dire as 1905's. With increased awareness about brain injury, reported concussions are on the rise among football players. But experts fear concussions may only be the tip of the iceberg. The injuries are almost invisible, but the stakes couldn't be higher: the brains of millions of young football players across the country.

Award-winning author Carla Killough McClafferty takes readers on a bone-crunching journey from football's origins to the latest research on concussion and traumatic brain injuries in the sport. Fourth Down and Inches features exclusive photography and interviews with scientists, players, and the families of athletes who have literally given everything to the game.

It's fourth and inches. Can football save itself again?

"More than eight million American high school students play sports, but at what price? McClafferty focuses on football to discuss the serious and historically trivialized condition of concussion. Starting with football's beginnings in the late 1800s as a rugby spinoff, McClafferty details the game's early casualties (in 1909 twenty-eight football players died of head injuries); the controversy over its growing presence as a college sport; and how it survived challenges to become 'firmly entrenched in American culture.' She then goes on to cover the insidious nature of concussions (because they are invisible, they are difficult to diagnose and easy to underestimate); the neuroscience behind head trauma; and the growing awareness of the dangers of concussion. Throughout, she works hard to balance the value so many young people put on playing sports with the significant risks involved. As she tells more and more stories of individuals who died playing football or lived lives blighted by pain, drug addiction, and personality changes, however, it's difficult to remain neutral. The book's organization can be hard to follow at times, and some subjects are dropped rather abruptly, but this is an informative and useful book on a topic of crucial importance to young athletes. Back matter includes a list of concussion symptoms, how and when to safely return to play, meticulous source notes, bibliography, suggestions for further reading, and an index." --The Horn Book Magazine

"A well-researched and readable informational text on sports concussions provides a strong case for greater understanding and awareness of their long-term effects.

Concerns about concussions in sports, especially football, have been increasing over the years and are particularly critical for young athletes. Worry about the violence and potential for serious injury have been part of football's history almost from the beginning. It was close to being banned in Georgia after the death of a University of Georgia student in 1897. The sport's possible brutality merited the attention of President Theodore Roosevelt in 1905, when he invited representatives from Harvard, Yale and Princeton to a meeting at the White House. But it survived and thrived. Improved technology, heightened awareness and high-profile cases of chronic traumatic encephalopathy (brain injury) have served to focus attention on the problem. In addition to providing historical context, McClafferty provides a clear and highly readable narrative by weaving in stories of affected athletes and researchers studying the problem. Along with the engaging writing, this volume has an arresting design that uses a catchy page layout, bold graphics and an excellent selection of photographs. A lofty level of research is reflected in the extensive backmatter, which includes source notes, an index, a bibliography and further reading as well as a medically approved list of concussion symptoms and return-to-play recommendations.

An important read for young athletes and the adults who care about them." --Kirkus Reviews

"McClafferty (The Many Faces of George Washington) sounds a dire warning about the dangers of playing football, especially at the youth level. As the first four of the book's 16 chapters point out, controversy surrounding football is as old as the sport itself: 'As the number of football-related injuries and deaths grew during the 1905 season, even Roosevelt wondered if this would ultimately lead to the death of the game.' The author, who readers later learn lost her toddler son to successive head injuries, presents story after poignant story of high school and professional players who suffered brain damage or worse. Among their profiles are details of research studies, photos of MRI images and damaged brain tissue, and explanations of chronic traumatic encephalopathy (CTE) and second-impact syndrome. The book builds a damning case against playing high-risk-of-concussion sports, though the narrative doesn't preach 'This is not now and will not ever be a simple issue, ' writes McClafferty in closing. This thoroughly researched and of-the-moment work concludes with appendices that include concussion symptoms and return-to-play guidelines." --starred, Publishers Weekly

"With both historical research and in-depth analysis of modern scientific studies, McClafferty has written an essential book concerning the hidden dangers of concussions in football. What starts out as a history of the early years of the game succinctly transitions into the modern dangers of America's most popular sport. Deftly placed, captioned images help to explain the effects that concussions have on the brain. Readers will relate to the personal stories the author tells concerning both young athletes in their prime and older athletes who have seen their lives deteriorate not long after their playing days are over. This book could serve report writers, but, more importantly, it can be a guide to parents and young athletes on how best to monitor and minimize head injuries. Endnotes include tips on how to tell if someone has concussion symptoms. Extensive source notes and a lengthy bibliography are included. An important and enlightening addition for all collections." --School Library Journal

"Anyone paying attention to football knows the concussion controversy is in sudden-death overtime. In this timely, well-thought-out overview, McClafferty explains how we got here, what's it doing to kids and young men, and where we might go from here. From the 1890s, football's appeal was its very roughness, and though 10 or 20 were dying of injury per year, even President Roosevelt supported the game. New rules led to fewer physical injuries--but there's the rub. Got a broken bone or torn ACL? You're rushed off the field. But even diagnosing a brain trauma is tricky. Cutely termed 'head ringers' back in the day, concussions are deadly--the stories of NFL players ruined in their early thirties or high-school players killed on the field are heartbreaking--and McClafferty counters the 'no pain, no gain' culture with graphics, brain scans, brain samples, and details of new studies tracking how concussions lead to devastating legacies of dementia and trauma. Solid, powerful material--this ought to make any football fan contend with the harsh realities of the sport." --Booklist