Should kids play tackle football? How the NFL’s concussion crisis has changed the game at every level.

Zachary Campbell plucked a football out of the autumn air and started to run.

He was a boy of just 10, but he was fast, and on this day in 2014, Zachary, a wide receiver, hauled in a pass and streaked toward the end zone on a football field in North Philadelphia.

His mother, Angela, watched from the sideline as two players from an opposing youth football team tackled her son. One slammed into Zachary up high, the other from below. Zachary was driven into the ground so hard that his helmet ricocheted off his head.

Instinct took over as Angela Campbell rushed from the sideline.

“I don’t even think I had time to think,” she later recalled. “My sister was standing next to me, and I just took off.”

After the game, Zachary appeared groggy. He complained to his mother that he felt dizzy, and he started to fall asleep as they drove home. She took him to Children’s Hospital of Philadelphia, where doctors diagnosed a mild concussion.

“But how many minor concussions can a person have?” she asked. “We’re talking about a child whose brain is still developing.”

In the days that followed, Zachary experienced dizziness, blurred vision, and sleep disturbances.

When his symptoms finally abated, though, Zachary told his mother that he wanted to resume playing football. He loved the game and missed his teammates.

Angela Campbell understood. But she wasn’t sure if she could allow him back on a football field.

What would happen, she wondered, if he suffered another brain injury?

» READ MORE: How dementia-stricken ex-Eagles fought to be compensated by the NFL’s controversial concussion deal

Families of young football players across the U.S. have grappled with similar questions for much of the last two decades, as concerns have grown about the long-term health effects of repeated head trauma.

The degenerative disease called chronic traumatic encephalopathy (CTE) has been found in the brains of hundreds of former football players, including ex-Philadelphia Eagles Guy Morriss, Frank LeMaster, Max Runager, and Maxie Baughan.

Medical experts have linked CTE — and other neurocognitive illnesses, like dementia, Alzheimer’s, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) — to the violent collisions that football players absorb.

Thousands of former NFL players sued the league in 2011, alleging that league officials had minimized or concealed the risks of concussions and subconcussive hits. Three years later, the NFL settled the case in U.S. District Court in Philadelphia and established a compensation fund for former players that has so far paid out more than $1.3 billion.

» READ MORE: Dick Vermeil and former Eagles speak out on the devastating impact of concussions and their fight for fair compensation

The NFL has since changed rules and introduced new helmets to help reduce concussions, and created an extensive protocol to manage players’ recovery from brain injuries. Many of those strategies have been adopted by colleges and high schools.

At its core, though, football remains a violent sport.

And in 2023, the Washington Post found that, since 2006, participation in football across the U.S. has plunged by 17%.

Parents, coaches, and educators continue to grapple with a thorny question, one that could pose an existential threat to the future of organized football: Even with changes to rules and equipment, is the game safe for children to play?

Much has changed about the way football teams approach player safety since the 1970s, when Jack Techtmann began his coaching career as a 20-year-old assistant at Archbishop Wood High School.

In that era, coaches were expected to be taskmasters who pushed players, even in high school, to the point of exhaustion through physically intense practices, fueled by the belief that it would better prepare them for games.

Techtmann, now 69, embraced a different approach in 2011, when he was hired to coach at Conwell-Egan High School, his alma mater.

“When I first took over,” Techtmann said, “I noticed we were missing players constantly to injuries.”

» READ MORE: Philly’s Frank Wycheck had a football career full of miracles — until concussions derailed his life

He began decreasing the amount of hitting that occurred during practices; now, the players on Conwell-Egan’s 60-man roster rarely tackle one another in practice. (Included among the team’s players are Techtmann’s grandson, sophomore Braydon Bond.)

Instead, the program has invested in tackling equipment: a three-foot padded doughnut that players pursue from different angles as it’s rolled across the ground, a four-pronged tackling dummy that returns to an upright pose after being hit.

For Techtmann and other high school coaches in the area, less physically punishing practices represent an element of risk that they can control, one that can be cited as proof that schools are doing all they can to ensure that young athletes have fewer opportunities to sustain brain injuries.

Jack Muldoon, the head football coach at Delaware County’s Msgr. Bonner and Archbishop Prendergast Catholic High School, meets with parents of the school’s football players before each season to address their concerns.

“I even have to reassure my wife,” Muldoon said. “My son is on the team.”

Muldoon played rugby for 20 years and borrows techniques from the sport, such as hawk tackling, which requires defenders to use their shoulders to strike opposing players — keeping their heads pointed away from the collision.

» READ MORE: Study, inspired by quarterback Tua Tagovailoa’s brain injury, identifies a new concussion symptom

“[Rugby] is an aggressive, rough sport, but you had to learn how to tackle without using your head, so I’m really big on form-tackling,” said Muldoon, whose Friars won the school’s first PIAA Class 4A championship Thursday.

The Seattle Seahawks are among the professional football teams that have incorporated hawk tackling into their style of play; other teams have emphasized gator roll tackling, which calls for defenders to wrap their arms around a ballcarrier’s legs, then roll them over to bring them down.

At Spring-Ford Area High School in Royersford, head coach Chad Brubaker employs a strength and conditioning coach, who focuses many of the team’s workouts around injury prevention.

“That’s our No. 1 concern,” Brubaker said.

At Mastery Charter North in Germantown, head coach John Davidson has players work with trainer Greg Garrett, whose King of Prussia gym, Level 40, has been frequented by numerous professional football players, including Atlanta Falcons tight end Kyle Pitts and Eagles defensive end Brandon Graham.

Davidson’s coaching staff also has been certified in USA Football’s Heads Up tackling program since he started Mastery North’s football program in 2011.

Heads Up began in 2012 as part of the NFL’s youth development arm, though early critics questioned if it was merely public relations for the league.

A 2021 study in the Clinical Journal of Sport Medicine, however, suggests Heads Up has helped lower concussion rates.

“At the end of the day,” Davidson said, “the safety and well-being of our kids is the priority. I want to win games, but I also want to make sure we play the right way so that when they’re done playing football, kids still have bodies that will allow them to function as human beings and normal adults.”

Once young athletes step onto a football field, though, the game is unpredictable. The smarter tackling techniques and extensive training regimens can’t eliminate offensive and defensive linemen colliding at the line of scrimmage, defenders sacking quarterbacks and bringing down receivers.

That’s why John Zeglinski is focused on protecting players’ heads.

» READ MORE: 1 in 3 former NFL players believe they have CTE, according to a new Harvard study

Zeglinski, who played football at Archbishop Ryan High School in the 1970s, is now the CEO of SAFR Sports, a Chester County company that sells protective helmet covers that sit atop existing helmets and are designed to lessen the impact of a blow before it reaches the headgear’s hard, inner shell.

Zeglinski, a former star wide receiver at Wake Forest University, cofounded the company in 2021 when “the game was under attack,” he said.

“Participation was down. [Football] has done a lot for my family, and I saw an opportunity to make it safer for future generations.”

SAFR isn’t the only player in the protective helmet market. NFL fans are by now familiar with the sight of Guardian Innovations’ Guardian Cap, the padded head covering that a handful of NFL players started to wear during regular-season games earlier this year.

According to Virginia Tech’s helmet lab, SAFR outperformed the Guardian cap used by high school and college teams, but not the thicker version used by NFL teams.

Several local schools use SAFR and Guardian products.

SAFR is “spring-loaded” atop existing helmets and incorporates team logos.

“No helmet will ever eliminate concussions,” said Zeglinski, whose son, Joe, coaches basketball at Archbishop Ryan. “… But the idea is to capture the energy before it gets to the hard shell, reduce the force of the hit, and make kids safer.”

Stephen Gambescia, a professor of health services administration at Drexel University, holds an unpopular opinion: He believes high schools should reconsider funding football programs.

Gambescia, 67, ran cross country at St. Joseph’s University; he appreciates the positive impact that participating in sports can have on a young person’s physical and mental health.

“All the things we think about with team sports … the whole idea of perseverance and discipline,” he said. “I would always advise students and explain to parents that most athletes will do better scholastically, because they’re managing their time better.”

» READ MORE: Navigating the NFL's concussion settlement isn't easy. Ask these former Eagles.

But he is troubled by the long-term costs that many football players pay for the brain-jarring hits they absorb.

A 2023 study published in the scientific journal Nature Communications argues that the likelihood of CTE is related to the number of blows to the head football players absorb in addition to the cumulative effect of those impacts across a career.

The investigation, according to a New York Times report, used data from 34 studies dating back 20 years and tracked the number and magnitude of hits measured by helmet sensors worn by 631 former players who donated their brains to studies managed by researchers at Boston University.

The Nature Communications study concluded that the cumulative force of hits to the head over the course of a career was the best predictor of brain disease later in life — not the number of concussions diagnosed.

“We’re dressing our kids up like gladiators with all these pads, and asking them to bang their heads and bodies against another person, the ground, or whatever else is in the way,” Gambescia said.

Yet former Neumann Goretti standout Justin Johnson argues that eliminating football in public schools would likely create more problems.

“It would do a lot of kids a disservice, and I think it would truly cause more harm to the city,” Johnson, 24, said.

» READ MORE: Wanting to be ‘more than a jersey number’: How Justin Johnson found life after football

During a scrimmage in 2019, Johnson, a 6-foot-7, 350-pound offensive tackle for the University of Oregon, blocked a defensive lineman, and then a linebacker on a run-pass-option play.

That second collision, he said, nearly made him vomit.

He felt disoriented. Sunlight bothered him. Coaches yelled to get ready for the next play. He couldn’t.

He was diagnosed with a concussion, and suffered lingering post-concussion symptoms. A team doctor finally encouraged him to retire.

» READ MORE: A timeline of the NFL’s concussion saga — and its impact on former Eagles

After the initial shock, anger, and disappointment, Johnson rebounded, graduating from Oregon with an undergraduate degree in public relations and a master’s in advertising. He also recently earned a master’s in education at the University of Missouri and currently works at Temple University.

“I had to come to terms that if I wanted to wipe my own behind by the time I’m 60 years old, then I should take the doctor’s advice,” Johnson told The Inquirer in 2023. “I’m a nerd. Football wasn’t my end all, be all, like a bunch of kids who wake up every day and their dream is to go to the NFL. I just wanted to get a free college education.”

Johnson says he would let his future children decide if they wanted to play football.

Former Florida State football star Myron Rolle, now a pediatric neurosurgeon, echoed similar sentiments.

“It’s a great sport,” Rolle said. “It’s done a lot for me. It’s provided me with education, friends, money, and characteristics that have made me a better physician, and I would hate to see the game go because we’re not prioritizing the safety around it.”

Rolle, 37, added a few caveats.

The former Rhodes Scholar who works at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., started playing tackle football at 6 years old.

He advises against that now, preferring kids play flag football until they learn the fundamentals of tackling in high school.

Flag football has increased in popularity for boys and girls. In September, the PIAA approved girls’ flag football as a state-sanctioned sport beginning in the 2025-26 school year.

Some local girls have even parlayed flag football skills into college scholarships.

Last year, the International Olympic Committee approved the sport for the 2028 Olympics in Los Angeles.

» READ MORE: Flag football has ‘totally empowered’ girls in the Philly area. That’s wonderful.

Even 7-on-7 football, which has become nearly as ubiquitous as AAU basketball in the summer, forbids tackling. It also has become a critical talent evaluation tool for college coaches.

Any discussion about the risks of playing football, Johnson said, should also weigh the opportunities that the sport provides for some young athletes.

“A lot of inner-city youths turn on the news and see all the God-awful things happening in the city,” he said. “There’s not a lot of positive lights being painted on the city, which conditions the youth to think, ‘I won’t make it out of the city.’ It almost conditions them to believe that they have no chance.”

Simon Gratz football coach Gene Faust last month told The Inquirer that football gives many of his players hope, a way to transcend the city’s harsh realities.

Johnson found hope when Albie Crosby, who coached Johnson at NG and Imhotep Charter, told him he could use football to get a scholarship.

Johnson’s collegiate journey has also inspired his younger siblings to seek higher education.

“The sport gave me motivation and an outlet because I had a leader with a blueprint for success,” he said. “It gave me fuel, a motivation to say, ‘OK, I can beat the odds and make it out,’ which made it more likely because I had a support system that most kids wouldn’t have if they just sat in the house.”

Angela Campbell agonized over whether she should allow her son, Zachary, to return to football after he suffered his first concussion at age 10.

“I kept telling him,” she said, “another injury and you can’t do this anymore.”

She had already nearly lost him during labor.

At 11 pounds, 13 ounces, Zachary had gotten stuck in the birth canal.

His heart stopped briefly inside a Washington, hospital, forcing an emergency cesarean section.

Doctors, Campbell said, asked her to choose between her life and her son’s.

“Of course, his life meant more to me than my own,” she said between tears. “I almost lost him, but he was a fighter in every sense.”

Ultimately, Campbell decided to let her son return to the game he loved.

And then he got hurt again, at age 14. This time, it was a broken ankle, suffered in practice when he leaped to make a catch.

Back home, he asked his older sister to wrap the ankle, and he tried to hide the injury from his mother.

She eventually found him crying in the bathroom from the pain.

A year earlier, he had chipped a front tooth playing football in the street when an errant elbow caught him in the mouth. When Angela attends games now in Springfield, Mass., she catches glimpses of the still-chipped tooth.

Perhaps it’s a reminder of how she protected her son, who has become a young man she hardly recognizes, in the best ways possible.

“Just in the way he speaks,” she said. “Even in his posture. He’s growing into a man everybody seems to see, but I still see that 5-year-old little boy sometimes.”

Zachary does, however, still have a dream many high school athletes share: make it to the pros and financially support his family.

Angela Campbell, however, refuses to put that responsibility on her son.

“We can get there in other ways,” she says. “It does not have to be [football]. Sometimes he sends me messages, like, ‘I love you, I’m going to take care of us.’”

She tells him: “If this is what you want, do it because it’s what you want. Don’t do it because you want to get me out of the projects or you want to stop me from having to work. I’m good with my life. You live yours.”

Last month, she watched Zachary — an imposing, versatile, 6-foot-4 forward who had starred on the basketball court at Murrell Dobbins Tech — play his first college basketball game as a freshman at Springfield College in Massachusetts.

It was his 19th birthday, nearly five years after she finally forbade him to play football.

“I’m happy with my decision to put his health first,” Angela Campbell said. “It wasn’t that I didn’t want him to play sports. I just wanted him to be safe. And in making that decision, he found his passion for basketball, and look at him now.”