Better Rules Can Help

Christopher Nowinski, a former Harvard defensive tackle, is a co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine, co-founder and president of the nonprofit Sports Legacy Institute, and author of "Head Games: Football's Concussion Crisis."

Professional football can be made “safer,” but to be made “safe” depends on your definition of the word. A sport involving full speed blocking and tackling will always cause injury. But injuries and safety are two separate concepts.

One way to make professional football safer is to change how we play youth football.

The great problem with brain injuries in the N.F.L. has been “informed consent” -- the disclosure of risk to the players. We allow adults to do all kinds of dangerous jobs for pay, from police officers and firefighters to commercial fisherman and miners. But the risk in those jobs are common knowledge, so we think those workers have informed consent.
That has not been the case with the risks of brain injuries in pro football. As reported by Alan Schwarz in the Times, the National Football League was not disclosing to players the risks of concussion and chronic traumatic encephalopathy (C.T.E.), the progressive brain disease that eventually leads to dementia, which were well known to academic researchers.

How often do concussions go unnoticed?

By not acknowledging the risks, sensible safety measures were not putting in place to protect the athletes. Now that the N.F.L. has evolved and is aggressively supporting education and awareness programs, research, and making adjustments to the game, informed consent will soon exist and we can focus on making the game safer.
Equipment, rule changes and penalties should always be assessed and reassessed in light of new research. I support recent changes in the N.F.L. and the N.C,A.A. and youth programs, including banning the wedge on kickoff return, assessing penalties for helmet-to-helmet hits on defenseless players, as well as changes in concussion management practices.
As for making the season shorter, that’s an interesting discussion that is mostly between the N.F.L. Players Association and the league. It’s difficult to quantify whether there will be increased risk of injury in swapping two preseason games for two regular season games, though starters who might skip the preseason games will now be at greater risk for injury.
I believe there is a separate, and better, way to make professional football safe(r): change how we play youth football. The reality is that the average pro football career is about three years; but a player almost always plays at least 10 years of football (youth, high school and college) before going pro, and some play 15 years prior to getting paid to play.
If we are worried about the cumulative effects of brain trauma, we need to adopt aggressive measures to prevent injury in the children’s game.
The developing young brain is far more vulnerable to the metabolic and chemical changes of concussion. Young people are also biomechanically vulnerable compared with adults. Having larger heads relative to their bodies along with weaker necks means that more force from hits to the head gets distributed to the brain rather than the body. And they have little to no access to medical professionals on the playing field, so there is a greater risk of concussions not being identified or being improperly treated.
The revelation that Owen Thomas, the 21-year-old co-captain at the University of Pennsylvania, who was already suffering from C.T.E. when he committed suicide in April, tells us that some players may enter the N.F.L. already suffering from C.T.E., , Therefore, our greatest opportunity to limit their long-term risk is to change their exposure before the N.F.L..
Football needs “hit counts” like youth baseball has “pitch counts.” In baseball, all kids are subject to restrictions because some may suffer cumulative injuries to their elbows. Yet in football we’ve never thought the brain, which is more important than the elbow, could be subject to the same kind of cumulative injury. That is insanity.
We should limit exposure to brain trauma risks for kids under 18 because they aren’t old enough to accept those risks. By doing that, we can significantly reduce the number of hits they will have suffered by the time they get to the pro level (perhaps by 50 percent). It seems to me that by making youth football safer we can most effectively reduce the risk for cumulative brain trauma going forward for pro players.