In 2013, the PBS Frontline Documentary “League of Denial: the NFL’s Concussion Crisis” began a nation-wide conversation about football and the role the sport plays in exposing athletes to potentially life-altering traumatic brain injury. With increased evidence coming to light linking TBI and the high-profile NFL, awareness of traumatic brain injuries and their consequences have been gaining traction with both the general public and in medical circles. But the discussion of youth sports injuries and TBIs is not new: a 2007 study looking at youth sports injuries between 1997 and 2007 found that concussion rates more than doubled among students ages 8-19 participating in activities such as basketball, soccer, and football, even as participation in those sports declined. 15.8 percent of youth football players who sustained a concussion severe enough to cause loss of consciousness returned to play the same day.

As these numbers and statistics circulated publicly they caused widespread alarm. Families with injured youth realized that the concussions and other sports injuries their children had sustained were not irregular accidents, but rather part of a trend that could be analysed and understood, and that measures could be made to prevent injuries while at the same time protecting “one of America’s most treasured traditions–amateur and professional sports,” as the mission of the Youth Sport Safety Alliance states.

Injuries on youth playing fields across the country concern coaches and parents alike, and fortunately these growing questions about concussions and how they are treated in young players have been magnified thanks to the increasing focus on TBIs in the NFL. People are closely watching the league’s response to the crisis of TBIs and chronic traumatic encephalopathy, or CTE, and athletic programs across the country are taking notice.

Rule Changes in the NFL

What the NFL defines as a legal hit has evolved over time, and continues to evolve as more scientific data and research emerges about the seriousness of the CTE and TBI issues in sports. When the NFL was created in 1920, its rules were based on college football. But within the first decades of its founding, the rules began to evolve in an attempt to facilitate more scoring and excitement for spectators. As football clothing became more durable and football helmets began being made of much sturdier materials, there was a growing illusion that players were adequately protected from increasingly forceful hits.

Over the years the NFL has made various safety-related rule adjustments, such as a 1956 change that made it illegal to grab the face mask of anyone other than the ball carrier, and 1979 changes that prohibited players on the receiving team from blocking below the waist during kickoffs, punts, and field-goal attempts; and instructed officials to quickly whistle a play dead when a quarterback was clearly in the grasp of a tackler.

By the 1990s, there was an increasing awareness of the risks of concussive hits to the players, and a string of head-protecting rules were added in the NFL: hits with the helmet or to the head by the defender were to be flagged as personal fouls and subject to fines (1996); it became illegal for a player to remove his helmet while on the playing field (1997); it became illegal to hit a quarterback helmet-to-helmet any time after a change of possession (2002); the definition of a “defenseless player” was expanded (2011); and it became illegal to lower a helmet crown to ward off defensive players (2013).

TBI Concerns Continue to Intensify

As we continue to learn more about the seriousness of the TBI and CTE crisis in sports at all levels, the public has become more aware of concussion protocols–concussion-assessment guidelines created to help detect concussions–being enacted everywhere from the sidelines of community-based sporting events to on the field in the NFL. The NFL announced the introduction of their set of concussion-assessment guidelines–developed by the league’s Head, Neck, and Spine Committee–in 2013 in an attempt to better detect the possible incidence of traumatic brain injury during practices and games. Football fans watching the Jaguars play the Patriots last Sunday saw the concussion protocol invoked for Patriots’ player Rob Gronkowski after he was the recipient of a particularly forceful hit to the head. In the NFL, the concussion protocol states that when a player is hit and loses consciousness, gets dizzy, holds his head after contact, looks confused, or gets up too slowly, this evidence of concussion requires the player to leave the field until medically cleared to return to play. As part of the assessment, viewing of video replay is required to clear a player of concussion.

It takes a lot to change rules in a juggernaut like the NFL, and the lynchpin to the most recent safety-related changes may be a $765 million-dollar concussion lawsuit brought against the NFL and settled in 2013. That lawsuit, brought by ten members of the Pro Football Hall of Fame, alleged that the NFL knowingly failed to protect their players from concussions even though they had decades of knowledge about the potentially devastating effects of repeated concussive and sub-concussive blows to the head. The effects of even mild traumatic brain injury include depression, dementia, and even suicide.

As we are seeing a growing accountability in the NFL for its role in protecting its players from life-altering experiences of traumatic brain injury, so too are we seeing a rising awareness of the importance of protecting younger and even more vulnerable athletes from their TBIs. However, as a 2017 article by Linda Flanagan in The Atlantic notes: “…concrete changes to laws and practices still lag behind the science. This is so partly because there is no overarching body to implement or enforce them, and partly because the culture of some sports, especially football, resists change.

As much as public awareness about the risks of concussion and TBI has increased in recent years, more research, action, and awareness are sure to come. Look for increasingly stringent concussion protocols the next time you are at a middle-school soccer game, a community softball game, or a professional football game. And if your local youth sporting organization doesn’t have one set up already, encourage the creation of a concussion baseline test for all of its players, in every sport. The health of all of our young athletes depends on it!