The league continues to make advances, on and off the field, in an effort to protect its players by championing new developments in engineering, biomechanics, advanced sensors, and material science that mitigate forces and better prevent against injuries in sports; supporting independent research to advance progress in the prevention, diagnosis, and treatment of head injuries; and sharing these learnings across all levels of football — and to other sports and society at large.
The NFL enforces rules changes aimed at eliminating potentially risky behavior that could lead to injuries. The Competition Committee, which spearheads the rules-changing process, reviews injury data after every season and examines video to see how injuries occur. More than a dozen NFL health and safety committees, subcommittees and panels provide input, as does the NFL Players Association. The Player Safety Advisory Panel submits formal recommendations directly to the Competition Committee and the Commissioner. Their analysis covers all injuries impacting players, including concussions and ACL/MCL tears, and considers how protocols and rules changes are making an impact on player safety.
Through rules changes, including the recent kickoff modifications and the "Use of the Helmet" rule — which states that it is a foul if a player lowers his head to initiate and make contact with his helmet against an opponent — the NFL is leveraging data in an effort to improve player safety and evolve the game.
For the “Use of the Helmet” rule change, for example, the comprehensive review of data and video led by the NFL’s medical and engineering advisors suggested that there may be an increased risk associated with lowering the head to align the neck and spine to initiate and make contact with the helmet. Accordingly, the clubs unanimously agreed to a rule change aimed at reducing that risk.
The review also showed that over the course of all games during the 2015-2017 seasons, the kickoff represented only six percent of plays but 12 percent of concussions. Data suggested that players had approximately four times the risk of concussion on the kickoff compared to running or passing plays. Accordingly, modifications to the kickoff rule addressed the components that were understood to pose the most risk, like the use of a two-man wedge, while maintaining the play. The Competition Committee worked with special teams coaches and NFL medical and engineering advisors to consider changes to the kickoff play during an owners and coaches session in early May. NFL clubs approved the Competition Committee’s proposal later that month during the Spring League Meeting.
The NFL and the NFLPA work together to protect players by outlining infractions or penalties for improper player conduct, dangerous plays or incorrect use of safety equipment. For example, the NFL requires players to wear thigh and knee pads during games to better protect them from leg injuries. As with helmets and shoulder pads, players not wearing the mandatory protective equipment are not permitted onto the playing field and may be fined.
Additionally, the league mandates the proper maintenance and testing of playing fields to reduce the risk of injury. In 2016, the NFL and NFLPA established the Field Surface Safety & Performance Committee to perform research and advise on injury prevention, improve testing methods and adopt tools and techniques to evaluate field surface performance and playability. It also oversees the NFL stadium inspection program, which includes testing of NFL playing surfaces by engineers retained by the NFL, under observation by NFLPA experts.
Each year, helmets undergo laboratory testing by biomechanical engineers appointed by the NFL and the NFL Players Association to evaluate which helmets best reduce head impact severity. The results of the laboratory tests are displayed on a poster and shared with NFL players, club equipment managers, as well as club medical, training and coaching staffs to help inform equipment choices. In 2018, based on the results of this study and the opinions of the biomechanical experts involved, the NFL and NFLPA prohibited 10 helmet models from being worn by NFL players. Moving players into better performing helmets is an important step toward reducing injuries, and it reflects the strong collaboration between the NFL and NFLPA to promote player safety. (Note: Laboratory test conditions are intended to represent potentially concussive head impacts in the NFL. Results of this study should not be extrapolated to collegiate, high school, or youth football.)
The NFL Musculoskeletal Committee has also coordinated extensive research on athletic shoe safety and performance. The committee has developed laboratory tests that evaluate which cleats best permit release from synthetic turf during potentially injurious loading. The results of those tests are set forth on the poster here, and shared with NFL players, club equipment managers, club medical, training and coaching staffs to help inform equipment choices. Other factors, in addition to the ranking, should be considered by players when choosing cleats, including fit, shoe structure, comfort, durability, player position and the player’s medical history.
On average, there are 30 healthcare providers at a stadium on game day to give immediate care to players. In conjunction with the NFLPA, the league has added unaffiliated medical personnel and adopted new technology to assist in the identification and review of injuries, with a specific focus on concussions.
NFL medical professionals follow the step-by-step NFL Concussion Protocol when they are identifying, diagnosing and treating player concussions. The NFL Head, Neck and Spine Committee — a board of independent and NFL-affiliated physicians and scientists, including advisors for the NFL Players Association — developed the NFL Game Day Concussion Diagnosis and Management Protocol in 2011. The Concussion Protocol is reviewed each year in an effort to ensure players are receiving care that reflects the most up-to-date medical consensus on the identification, diagnosis, and treatment of concussions. For the 2018 season, additional improvements were made to the Concussion Protocol.
After a 16 percent year-over-year increase in concussions during the 2017 season, NFL Chief Medical Officer Dr. Allen Sills issued a call-to-action to reduce concussions. The result was the Injury Reduction Plan, a three-pronged approach to drive behavioral changes:
The NFL is investing in and supporting preeminent experts and institutions to advance progress in the prevention, diagnosis and treatment of head injuries.
$40 million in funding has been allotted in the Play Smart. Play Safe. initiative for medical research over five years, primarily dedicated to neuroscience. The NFL has assembled a Scientific Advisory Board (SAB) — chaired by Peter Chiarelli, U.S. Army Gen. (Ret.) — of leading independent experts, doctors, scientists and clinicians to develop and lead a clear process to identify and support compelling proposals for scientific research. In September 2017, the SAB opened a funding opportunity for innovative translational research on concussion and comorbid conditions.
The NFL also contributed approximately $14 million to the Foundation for the National Institutes of Health to advance medical research on brain injuries, especially among athletes and veterans. The grants included $12 million for pathology studies through the Sports and Health Research Program (SHRP) and six pilot projects totaling more than $2 million to provide support for the early stages of sports-related concussion projects.
In January 2018, the NFL announced $16.3 million in funding for a series of government-funded projects — including prospective, longitudinal, multi-site, peer-reviewed efforts to answer leading questions on traumatic brain injury, concussion and provide insights on neurodegenerative diseases, including CTE, as well as other cognitive impairments related to aging.
Learn more about the NFL’s support for medical research.