Head Games: Examining the NFL’s Evolving Concussion Protocol and Player Safety Measures

The roar of the crowd, the bone-jarring hits, the thrill of victory – these are the hallmarks of the National Football League. Yet, beneath the surface of this captivating sport lies a growing concern: player safety, particularly concerning concussions. In Super Bowl LIX, Kansas City Chiefs quarterback Patrick Mahomes took a hard hit in the fourth quarter. While he was cleared to return, the incident reignited the ever-present debate about the NFL’s concussion protocol and the long-term health of its players. This isn’t just about one game; it’s about the future of the sport.

A History of Head Trauma in the NFL

The NFL’s relationship with head injuries has been a long and complex one. For years, the league downplayed the risks associated with concussions, but mounting evidence and pressure from players, medical professionals, and the public have forced a change. In 2009, amidst lawsuits from former players, the NFL began revamping its concussion protocols, acknowledging the connection between head injuries and long-term neurological problems. This marked a turning point, leading to the implementation of various safety measures and rule changes aimed at reducing head trauma.

The NFL’s Evolving Concussion Protocol

The NFL’s concussion protocol is a multi-step process designed to identify and manage players who have sustained a head injury. The protocol is initiated when a player exhibits or reports symptoms or signs suggestive of a concussion. This can be triggered by the team’s athletic trainer, booth spotter, team physician, game official, coach, teammate, or an Unaffiliated Neurotrauma Consultant (UNC).

The protocol involves a sideline survey, where the player removes their helmet for examination by the team doctor and UNC. If a player has lost consciousness or displays confusion, amnesia, or a lack of muscle control, they are immediately ruled out of the game. The medical team reviews the play and asks the player a series of questions to assess their cognitive function.

If a concussion is suspected, the player enters the Return-to-Participation (RTP) protocol, a five-step process:

Rest and Recovery: The player is prescribed rest and told to limit activities that increase symptoms. Limited stretching and balance training can be introduced under supervision.
Light Aerobic Exercise: The player engages in light aerobic exercise, such as walking or stationary cycling, while being monitored for any return of symptoms.
Football-Specific Exercise: The player progresses to football-specific exercises, such as running and agility drills, still under close supervision.
Training Drills: The player participates in non-contact training drills, gradually increasing intensity and complexity.
Full Football Activity: The player is cleared for full football activity, including contact, after being evaluated by the team physician and an independent neurological consultant.

A player cannot return to play until they have successfully completed each step of the protocol and are cleared by medical professionals. There is no set timeline for this process, as recovery time varies from player to player.

Recent Data and Trends

The NFL recently announced injury data for the 2024 season, revealing a significant decrease in concussions. Concussions decreased 17% compared to the 2023 season and 12% compared to the 2021-2023 season average. This decrease builds on a record preseason, which had the fewest number of concussions in practices and games since 2015.

NFL Chief Medical Officer Dr. Allen Sills and NFL EVP of Player Health & Safety Jeff Miller attributed the drop to several factors, including helmet quality and the mandatory use of Guardian Caps for most players during training camp and regular-season practices. According to Sills, 35% of all players upgraded their helmet quality in 2024.

The new Dynamic Kickoff rule, implemented in 2024, also contributed to the reduction in injuries. Returns increased 57% in the regular season, and the new rule slowed average player speeds, leading to a 43% lower concussion rate compared to the 2021-2023 average.

The Guardian Cap and Other Equipment Innovations

The Guardian Cap, an additional layer of padding that attaches to players’ helmets, has been a significant development in player safety. While mandated for some players during practices since 2022, it was approved for use in regular-season games in 2024. The cap is designed to absorb and spread the force of a hit, purportedly reducing the force of impact by up to 25 percent.

However, the adoption of the Guardian Cap has been met with mixed reactions. Some players, like Miami Dolphins quarterback Tua Tagovailoa, have chosen not to wear it. Despite claims that concussions are down by over 50 percent in players who wear them during practice, only an average of six players wore them each week in the NFL and the Canadian Football League combined in 2024.

Rule Changes and Enforcement

In addition to equipment innovations, the NFL has implemented numerous rule changes aimed at improving player safety. These include:

The “Use of the Helmet” Rule: This rule penalizes players who lower their head to initiate and make contact with their helmet against an opponent.
The Dynamic Kickoff Rule: This rule, made permanent in 2025, is designed to reduce high-speed collisions on kickoffs by aligning players closer together and restricting movement.
Expanded Replay Assist: On-site officials can now reverse penalties for hits to defenseless players, face mask grabs, horse collar tackles, tripping, and running into/roughing the kicker if clear video evidence is present.
Onside Kick Rule Updates: Teams can now declare an onside kick at any time in the fourth quarter if trailing, with new formation rules to limit player alignment and movement.

The NFL and the NFL Players Association (NFLPA) work together to protect players by outlining infractions or penalties for improper player conduct, dangerous plays, or incorrect use of safety equipment.

Independent Neurological Consultants

Since 2013, the NFL has required independent neurological consultants (UNCs) on the sidelines during games. These neurologists are not directly employed by the teams and are intended to provide an independent voice in concussion evaluations. However, some have questioned the true independence of these consultants, as they are still paid by the league.

UNCs have the final say on whether a player returns to the game after a suspected concussion. They work with the team physician to evaluate the player and determine if they have exhibited any “no-go” symptoms, such as loss of consciousness, confusion, amnesia, or gross motor instability.

Challenges and Criticisms

Despite the progress made, the NFL’s concussion protocol and player safety measures continue to face challenges and criticisms. Some argue that the protocol is not always strictly followed, particularly in high-stakes games. Others point to the potential for conflicts of interest, as team physicians may feel pressure to clear players to return to play quickly.

A recent case involving Buffalo Bills cornerback Christian Benford highlighted potential gaps in the NFL’s concussion management. Benford sustained a concussion during a playoff game but was cleared to play in the AFC Championship Game just seven days later, raising questions about whether the league’s RTP standards are genuinely enforced when stakes are high.

There are also concerns about the long-term effects of repeated head trauma, even if concussions are properly managed. Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease, has been found in the brains of numerous deceased NFL players, raising awareness of the potential long-term consequences of playing football.

The Future of Player Safety in the NFL

The NFL has made significant strides in improving player safety, but more work remains. Continuous efforts are needed to reduce both the frequency and consequences of concussions in the sport. This includes:

Further research into the long-term effects of head trauma.
Development of more effective helmets and protective equipment.
Continued refinement of the concussion protocol.
Stricter enforcement of safety rules.
Promoting a culture of safety among players, coaches, and team personnel.

The NFL’s commitment to player safety is not only essential for the well-being of its athletes but also for the long-term viability of the sport. By prioritizing player health and investing in research and innovation, the NFL can ensure that football remains a captivating and sustainable sport for generations to come.