By Kim Diggs
As the concern with the long-term effects of football in athletes grows, discussions about chronic traumatic encephalopathy have become more highly publicized. During the 70th NATA Clinical Symposia & AT Expo, NFL Chief Medical Officer Dr. Allen Sills addressed these concerns during the two-hour session, “Is There a Future for Football: Ronnie Barnes Case Studies in the NFL,” June 27. This lecture series was presented by the Professional Football Athletic Trainers Society.
The notion that football is too dangerous to be played seems like a new school of thought to many, as it has been debated in the media in recent years. However, Sills said this sentiment has been in the ether since the early 20th century.
During Theodore Roosevelt’s presidency, he was tasked with addressing the high number of deaths and serious injuries to football players. In response, he organized a coalition to discuss the future of football to determine if it could be reformed or if it needed to be banned in the United States. Choosing to reform the sport by banning the flying wedge and implementing the forward pass, President Roosevelt and the group decided to meet once a year to discuss new changes that could be implemented to improve safety. This group was later named the National Collegiate Athletic Association.
Over the past five years, the NFL has funneled an estimated $235 million into medical research to further preserve the health and safety of players, Sills said. A large percentage of the funding contributes to the betterment of neurologic health in the NFL.
“I didn’t know this until I began working with the NFL two years ago,” Sills said. “I had no idea the magnitude of that investment. More particularly, last year, we announced $35 million more in funding, really directed toward these issues of long-term health in athletes, specifically, around CTE-related issues.”
Though CTE has become a prevalent topic in sport, there are still many unknowns. As health care professionals, athletic trainers, physicians and health care teams at large are looked at to answer the tough questions about the condition, and, in order to begin that process, deep research and analysis is paramount, Sills said.
“CTE is a very real, pathologic entity,” Sills said. “It has been best studied in autopsy series. But, we still have so much to learn. We’re in our infancy in understanding who’s susceptible. What is the pathophysiology? What is the mechanism? Can we modify it? Are there comorbid conditions?”
Though there is pressure on the medical field to address concerns about CTE, there is no way to estimate when those discoveries will be made. In the meantime, a dedication to concussion prevention is key, Sills said.
When Sills joined the NFL in 2017 as the chief medical officer, his goal was to drastically decrease the number of concussions occurring across all 32 clubs during preseason and regular season with the hopes that the data gathered could be used to, eventually, benefit all institutions participating in the sport.
In 2017, the NFL concussion rate was at an all-time high with 291 overall in the league, Sills said.
His assessment was that, on a macro level, the equipment used and the way the game is played were the biggest contributing factors to concussions and it was important to examine game play and injuries down to a micro level, employing data analysis and bioengineering to reduce the rate of concussions.
In accordance with his plan, all clubs reported to the same electronic health record and game day medical reports were received from all independent personnel. This data was compiled by IQVIA, an epidemiology company. Bioengineers captured video of injuries and applied statistical methodology to determine the cause of injury and form a plan for injury prevention with the rest of the medical team.
During the initial research and data gathering phase, engineers compiled a video review of every concussion that occurred in the past five years, analyzing 150 variables, which included who hit who, the speed, the play and which part of the helmet was involved, Sills said.
Due to that research, Sills said offensive linemen might wear a different type of helmet than quarterbacks and running backs in the next two to three years because they tend to be impacted in different areas of the head.
New helmets were tested in labs, gauging how they performed during impact. After a series of tests, the medical team had a goal of replacing the helmets of the players in all 32 clubs. These new helmets were outfitted with radiofrequency identification (RFID) tags to track the impact each player is experiencing.
Some of the findings from the data collected so far were that 60 percent of the players tackling suffered a concussion, especially if there is a head-to-head collision, Sills said. Head-to-head impacts are five times more likely to result in a concussion than head-to-lower-body impacts.
The data from the new helmets also led to the realization that two out of three concussions occurred during blindside blocks, Sills said, resulting in them being banned by the NFL in March.
To date, more than 70 percent of the league has used the new helmets and Sills’ goal is for every player to be wearing the new helmets by the end of the year.
Though there is a major focus on concussion prevention, Sills also pushed for overall injury prevention, analyzing occurrences in the lower extremities as well.
Taking a similar approach to the head injury analysis, new cleats were outfitted with RFIDs to capture all movement and impacts.
The medical team’s findings showed that eight out of the 11 most catastrophic injuries occurred in the lower extremities, with anterior cruciate ligament injuries at No. 1.
Sills has had conversations with surface manufacturers to produce surfaces designed to reduce lower extremity injuries.
“The mount and the depth of rubber pellets have a huge impact on some of these ankle injuries,” Sills said. “You can’t just put down an artificial surface and just leave it and think it’s going to function the same all year-round.”
Due to all of the efforts of the medical team, missed time for injuries has decreased overall by 30 percent, Sills said.
The ultimate goal behind this extensive testing is to create a blueprint for safety that can, eventually, be adapted to fit schools across the country. For more information, visit www.playsmartplaysafe.com/newsroom/videos/behind-scenes-nfl-medical-committees-combine.