The National Football League (NFL) and NFL Players Association (NFLPA) recently announced changes to the League’s concussion protocol. The new elements of the protocol will discipline teams that violate the required procedures.
According to the updated policy, a representative will be designated by the NFL and NFLPA to monitor how teams adhere to the protocol. That representative will also be responsible for investigating any possible violations. However, no medical conclusions will be drawn from the investigation; rather, the focus will be on compliance with the NFL’s game-day concussion protocol.
The NFL and NFLPA will then review the circumstances surrounding any potential violations. If the NFL and NFLPA cannot determine the appropriate disciplinary actions for a violation together, then a third party arbitrator will be utilized. NFL Commissioner Roger Goodell ultimately will determine the penalties for violating the protocol.
In the case of a violation of the concussion protocol, the following disciplinary actions will be applied:
“A first violation will require the club employees or medical team members involved to attend remedial education; and/or result in a maximum fine of $150,000 against the club.
Second and subsequent violations of the concussion protocol will result in a minimum fine of $100,000 against the club.
In the event the parties agree that a violation involved aggravating circumstances, the club shall be subject, in the first instance, to a fine no less than $50,000. The Commissioner shall determine appropriate discipline for subsequent violations involving aggravating circumstances.
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In the event that the Commissioner determines that the club’s medical team failed to follow the protocol due to competitive considerations, the Commissioner may require the club to forfeit draft pick(s) and impose additional fines exceeding those amounts set forth above.”
With the addition of these changes to the policy, the process of evaluating how teams follow the protocol is refined. According to a league source, the NFLPA threatened to bring medical malpractice actions against team and league medical personnel assigned to games who mishandled concussion management, forcing the league to make changes to the policy.
Much of the NFLPA’s dismay stemmed from the mishandling of St. Louis Rams’ quarterback Case Keenum’s concussion last season. The NFLPA considered bringing a malpractice claim against the Rams under Article 50 of the NFL’s collective bargaining agreement. The NFL sought to avoid future issues like this by implementing a disciplinary system for teams who fail to properly follow the protocol. Also inspiring these changes was the NFL’s data showing an approximately 32% increase in concussions during the 2015 NFL season.
These changes do not focus on reducing the number of head injuries on the field, but removing those from the game who may be suffering from a concussion. Having these players leave a game to heal could reduce concussions overall in the long-term, because a player that does not fully heal from the first concussion is more susceptible to suffering another. However, this policy only looks to help ensure those who are injured leave for testing, but it does not ensure that players will not return too soon from a concussion.
While the NFL certainly must take action to reduce the number of concussions that take place during a game, suffering a concussion will always be a risk of playing football. Therefore, it is imperative that players that may be suffering from concussions are removed from the game immediately to undergo the concussion protocol and avoid further injury.
This appears to be a commendable move by the NFL since the concussion protocol needed stricter enforcing. However, if the NFL had a better history with concussions as a whole, there may not be a need for numerous updates to the policy.
The NFL’s Head, Neck and Spine Committee created a game day concussion protocol for NFL teams to follow back in 2013. The NFLPA, NFL Physicians Society, and Professional Football Athletic Trainers Society contributed to the policy. Since all concussions are so unique, the protocol states: “Therefore, there is no set time-frame for return to participation or for the progression through the steps of the graduated exercise program set forth below. Recovery time will vary from player to player.” The five steps outlined in the protocol are: rest and recovery, light aerobic exercise, continued aerobic exercise/introduction of strength training, football-specific work, and full football activity/full clearance.
The NFL also added concussion spotters. In 2015, these spotters were given the authority to stop play if a seemingly concussed player did not leave the game. That player would then be required to undergo a concussion test and sit out at least one play. The NFL’s Senior Vice President of Health and Safety spoke about this change: “We don’t expect this to happen a lot, but the athletic trainer is now empowered to stop the game if necessary to give the player the attention he needs. Concussions and head and neck injuries are really important and they need immediate attention. Therefore that was going to predominate over any potential competitive concerns.”
However, if the NFL was so concerned about concussions, why was the enforcement not strict from the beginning? After introducing concussion spotters for the sole purpose of scoping for concussions, there should not have been breakdowns like in the Case Keenum situation. What was the purpose of enacting these policies, if not to use them? Was enacting these policies just a way to improve the optics and make it appear as though the NFL is genuinely concerned with their players suffering head injuries?
The NFL’s main concern is likely not the actual protocol itself, but application of the protocol. More important than making sure the system is flawless, is making sure that it is actually used. The protocol is not a flawless system; however, having a perfect system that is never used would likely be more detrimental to the league in the long-term. Constantly hearing that players are undergoing the mandated concussion protocol would, at minimum, give the appearance that the NFL is being extremely proactive on concussions.
Many are going to be skeptical of anything the NFL does regarding concussions because of the league’s complicated history with concussion management. The NFL has attempted to control the narrative many times to make it appear that the league is making landmark strides in their concussion management, while restraining the research on concussions to relieve the pressure they face. Hopefully from here forward the league will be more proactive, especially since former head of the NFL’s Mild Traumatic Brain Injury committee Dr. Elliot Pellman is retiring––which could result in a completely different outlook on concussions as a whole. That said, Pellman was not the only person contributing to the NFL’s questionable positions on concussions.
Even more skepticism stems from the policy granting Commissioner Goodell the ultimate authority over penalizing teams that violate the policy. If the NFL and NFLPA cannot come to a consensus on what the discipline should be, Goodell has the final authority. And if Goodell disagrees with the arbitrator’s penalty, Goodell can overrule the decision. The Commissioner’s authority has been under a microscope after his approach to numerous situations including Deflategate and Ray Rice. Giving Goodell more authority to make such consequential decisions is questionable at best.
The NFL implemented a policy to enforce other policies that should have been enforced in the first place––especially since these policies are designed specifically to identify concussions and protect their greatest assets: the players. The NFL may be prioritizing the health and safety of players, but another update, this one to actually enforce the prior policies, should not have been necessary. One alternative explanation for the change is that the NFL is genuinely displeased with the failings of the protocol that amplify how inadequate the league has been at handling concussions. Because without administering the concussion protocol, players like Case Keenum who are so glaringly concussed are on display for the world to see.