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As the buildup to the Super Bowl intensifies over the next week, there will be plenty of discussion about the state of the NFL. From all I've seen with head trauma in football, I believe we will see a steady decline in the NFL and college football over the next 10 to 20 years.
The NFL continues to promote the idea of creating a safer sport, but there is no way to completely eliminate the risk of brain damage in football. I do think there are changes we could make to at least decrease that risk. These ideas could keep the sport somewhat close to the way it's played now.
Let's start with ideas for all levels of football, and not just the NFL.
Mandatory medical staffs: The NFL requires over 30 medical personnel at every game. At the youth and high school levels, there is often little medical coverage at all. High school teams should have an athletic trainer at every practice and game. A doctor should be present on the sideline of both teams at every game. If such coverage isn't possible, the team can't play.
Flag football until high school: Evidence shows that the concussions and repetitive subconcussive blows might do more harm to kids whose brains are still developing. Young athletes can play flag football to learn the movements and strategies of the sport without sustaining hundreds of brain impacts from tackling and blocking each season.
If you're worried that change will prevent a kid from succeeding in the sport, understand that Tom Brady and Jerry Rice, arguably the two greatest players of all time, did not play tackle football until high school.
Non-contact practices: More and more research points to the role of repetitive subconcussive blows as the culprit in CTE, the degenerative brain condition that has affected many former players. Football players withstand a huge number of these impacts over a long career. By making practices non-contact, we can dramatically decrease the cumulative effect of these blows.
Elimination of the three-point stance: Linemen absorb many hundreds of repetitive subconcussive impacts each season, which is largely why many of the former NFL players diagnosed with CTE have been offensive and defensive linemen. Removal of the three-point stance, in which a lineman crouches with his hand on the ground, allowing him to launch himself at the opposing lineman, should greatly decrease the impacts over an athlete's career.
Mandatory brain trauma education: Athletes at all levels need to understand the risks of playing football. Maybe ex-49er player Chris Borland, who retired early into his career out of fear of the health risks in football, could speak to them. Or Dr. Chris Nowinski of the Concussion Legacy Foundation or Drs. Ann McKee or Robert Stern of Boston University's Chronic Traumatic Encephalopathy Center could offer live or online presentations. Players would be required to watch them to be cleared to play.
When it comes to the NFL specifically, here are a few more ideas to make the game safer.
Mandatory one-game absence after a concussion: Any player diagnosed with a concussion would be required to miss at least one game, regardless of where in the concussion protocol a player might be. Protocols would have to be in place to make sure teams didn't use "concussion-like symptoms" or some other loophole to avoid a concussion diagnosis and the mandatory one-game absence.
Removal from the game for signs of a serious head injury: If a player suffers a hit that causes him to stumble, fall or struggle to stand (think Travis Kelce or Cam Newton) or exhibits a motor sign of a serious injury (think Tom Savage), that player must be pulled out of the game and may not return. Ignore the argument that players go down intentionally to save the team from using a timeout.
Medical staff availability to the media: This idea will never happen out of concerns for patient privacy. Still, the possibility of the team's head athletic trainer or physician having to face a room full of reporters and explain why a player was in the medical tent for 10 seconds after what looks like a concussion might make them follow the concussion protocol more closely.
Create a licensing board: Much like boxing, where a fighter must get a license from a medical advisory board to fight in a state, a player could be required to be examined by independent doctors. Maybe an annual brain MRI, or a CTE test when one is available, could be part of the licensure process.
Dr. Geier is an orthopedic surgeon in Charleston and author of 'That's Gotta Hurt: The Injuries That Changed Sports Forever.'
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