NFL Rule Changes

In the years since the publication of Dr. Omalu’s paper, the NFL has implemented 44 rule changes focused on protecting players—almost double the number of rule changes made in the years prior.

In 2018, the league broadened helmet-hit rules to penalize players who initiate contact with an opponent leading with the crown of their helmet on any play. It also proposed changes to kickoff rules that include eliminating a running start for the kicking team in order to reduce the number of concussions resulting from what some commentators have called the most dangerous play of the game, due to the velocity that running players on both sides can reach during a kickoff return. 

Not insignificantly, the physician appointed as the NFL’s chief medical officer in 2017 is a neurologist—Allen Sills, MD, the founder and former co-director of Vanderbilt University’s Sports Concussion Center.

“In my opinion, the NFL has taken the lead on establishing protocols and educational outreach on all efforts concussion-related,” says Tad Seifert, MD, of the Norton Healthcare Sports Neurology Program. “That has a trickle-down effect to college and youth sports levels.”

“The problem is, unless head impact prevention is part of the ethos of sport, these changes might offer the same advantage as filters on cigarettes,” says Chris Nowinski, PhD, of Boston University’s Chronic Traumatic Encephalopathy Center “meaning they don’t prevent enough.” 

Concussion Protocols 

Concern over concussion has prompted the organization United States Club Soccer to ban heading the ball in games or practices for players under 11. The Concussion Legacy Foundation recommends that children under 14 avoid tackle football, but youth football league policies vary. Wherever sports are played, the National Collegiate Athletic Association Sport Science Institute makes these recommendations:

1. Perform pre-participation baseline assessments of all athletes.
2. Remove athletes from play if they experience signs, symptoms, or behaviors consistent with concussion.
3. Refer players to a trainer or physician with experience in concussion management.
4. Have athletes follow an individualized concussion treatment plan that involves multiple clinical assessments and a return to activity or sports when clinically appropriate.

For more about concussion among young athletes, read “Heads First,” our story on the topic.