3. Limit full-contact practices in football
In response to the growing body of scientific evidence showing that repetitive head impacts (RHI) can have both short- and long-term effects on the brain (including CTE), rules limiting RHI exposure have been adopted over the past several years at every level of fooball:
National Football League
The National Football League has eliminated off-season full-contact practices and now allows only 14 full-contact practices during the season, less than one per week.
College football
Limits on full-contact practices is coming more slowly at the college level:
- In 2011, the Ivy League imposed limits on full-contact practices, allowing only two full-contact practices per week.
- In June 2013, the Pac-12 announced that it would adopt a policy limiting full-contact practices. The next month, the conference announced that the limit would be two a week, the same as the Ivy League. No other major college football conference has followed suit, at least so far.
- On July 7, 2014, the NCAA issued guidelines [38] recommending, but not mandating, that full-contact practices be limited to two per week during the season. The NCAA guidelines also recommend four contact practices per week during the preseason and no more than eight of the 15 sessions of spring football. A recent study by researchers at the University of Virginia Medical School of impacts to the head in college football,[37] however, was sharply critical of the NCAA for the failure to impose mandatory limits on full-contact practices, which was based on a lack of data and one unpublished presentation, noting that, "Effectively, the NCAA defers to the individual athletic conferences and teams regarding the regulation of football practices." The limits on in-season contact practices mandated by both the Ivy League and Pac-12, and by the NFL, and the data from their study showing that the number of head impacts and severity was highest during full-contact practices, the authors said, "suggest that similar regulations in college football would reduce the burden of head impact for thousand of athletes. While the research community should continue to investigate the cause and nature of these practice type differences, the potential human cost of leaving practice equipment unregulated seems," they concluded, "unnecessarily high."
High school football
Limits on full-contact practices have been enacted or recommended at the high school level:
- In 2013, state high school athletic associations in Arizona, Washington State, Iowa, Maryland, Alabama and Texas moved to impose some limits on full-contact practices. Preliminary High School RIO injury surveillance date suggest these states have seen a statistically significant decrease in concussion rates during practices, with no increase in concussion or other injuries during games.
- On July 21, 2014, California governor Jerry Brown signed into law AB 2127, limiting middle and high school to two full-contact practices - each no more than 90 minutes long - per a week during the 30 day period before the regular season and during the regular season itself, and banning off-season contact practices completely.
- In advance of the 2014 season, the Wisconsin Interscholastic Athletic Association mandated new limits on the amount and duration of full-contact activities during team practices, prohibiting full contact during the first week of practice, limiting full contact to 75 minutes per week during week 2, and capping it at 60 minutes thereafter.
- In November 2014, the National Federation of State High School Associations (NFHS) recommended to its member associations that they adopt limits on full-contact practices in high school football. The recommendations, contained in a position paper issued by the NFHS Concussion Summit Task Force in July 2014,[34] were approved by the NFHS Sports Medicine Advisory Committee and the NFHS Board of Directors, and discussed by the 51-member state associations at the NFHS Winter Meeting in early January 2015. The NFHS guidelines recommend to state athletic associations that they:
- limit full-contact practices during the regular season, as well as during activity outside of the traditional fall football season;
- allow no more than 2 to 3 full-contact practices per week; and
- Consider limiting full-contact on consecutive days, to no more than 30 minutes per day, and to no more than 60-90 minutes per week.
- In 2013, Preliminary High School RIO injury surveillance data suggested that the limits on full-contact practices in Texas had resulted in a statistically significant decrease in concussion rates during practices, and that similar results were seen in Arizona, Maryland, and Alabama after comparable changes were made to practice rules in those states.
- In the months leading up to the 2015 fall season, some state associations adopted the NFHS recommendations exactly, while others altered them to more closely fit the needs of their member schools:
- the state associations in Iowa, Kansas, Georgia and Tennessee opted to limit full-contact practice to 90 minutes a week.
- Other states, such as Ohio, chose to limit full-contact to 60 minutes a week instead.
- The Kansas State High School Activities Association (KSHSAA) was one of many state associations to make pro-cactively make changes to its football rules that went beyond the recommendations of the NFHS Task Force. For example, players in Kansas are no longer be able to participate in "Live Action" the day after a game. And, effective with the 2016 season, they will not be allowed to participate in games on consecutive days, a change was made to address the issue of student-athletes playing a varsity game followed by a junior varsity game the next day.
- Many states have also enacted rules changes establishing a progression up to full-contact in preseason practices, similar to the heat acclimatization schedules integrated into preseason workouts in recent years. For example, the Illinois High School Association (IHSA) limits equipment to helmets only during the first two days of practice, helmets and shoulder pads the next three days, with full pads only being introduced on the sixth day of the acclimatization period. Similar progressions have also been adopted in Alabama, Minnesota and Kansas, among others.
Interestingly, a recent study by Purdue researchers provides support for such a progression. finding that cerebrovascular reactivity (CVR) - a measure of the ability of blood vessels in the brain to dilate to compensate for increased levels of carbon dioxide in the blood, such as occurring during exercise - was significantly reduced in almost all football athletes during the first six weeks of the contact season, findings which the researchers viewed as demonstrating that the onset of subconcussive blows had "at least a transient effect on the brain, but also suggest[ing] that the brain can adapt to [the contact] with an eventual return to baseline."The researchers expressed concern that athletes may be at risk of incurring symptomatic injury during period their brains were trying to adapt to contact at the beginning of the season. Noting that in most states football teams typically switch from limited contact levels during the preseason to two practices a day, at least one of which includes contact, they expressed concern that, based on their findings, "the brain may not be able to adjust quickly to this change, leaving players at increased risk for injury" at the beginning of the football season. They thus suggested that it might be better for teams to increase the amount of contact more gradually to allow players' brains to adapt so as to reduce the risk of serious injury. This is what the new rules in Illinois, Alabama, Minnesota, and Kansas appear to address. Whether they go far enough is another question.
- Prompted by the NFHS Task Force recommendations, member state associations have been reviewing there policies concerning offseason football. In states such as Ohio and Illinois, there were already rules in place to limit contact during the offseason, with teams prevented from participating in full gear or in full-contact practices. Other states that previously had no restrictions in place for offseason football have begun to adhere to the NFHS task force's guidelines as well.
Youth football
- In June 2012, Pop Warner - acting on the advice of its Medical Advisory Board and input from its regional and local administrators and coaches, and in light of developing concussion research (including the 2012 Virginia Tech/Wake Forest study [6] of impacts in youth football which recommended a reduction in contact drills during practice) - adopted rule changes for the 2012 season designed to limit contact during practices in order to reduce concussion risk (and cumulative brain trauma). [27] Pop Warner now prohibits full speed head-on blocking or tackling drills in which the players line up more than 3 yards apart. Although drills in which two lineman in stances immediately across the line of scrimmage from each other and those in which the players approach each other at an angle is still allowed, no straight ahead contact outside of the 3 yard zone or intentional head-to-head contact is permitted. In addition, the amount of contact at each practice has been reduced to a maximum of 1/3 of practice time (either 40 minutes total of each practice, or 1/3 of total weekly practice time, with "contact" meaning any drill or scrimmage in which drills; down line vs. down line full-speed drills; and scrimmages).
- A 2013 study [30] found that adoption by a youth football team which, though not affiliated with Pop Warner, of its new practice rules, did not lead to higher force impacts during games as compared to hits to the head sustained by players on two teams that did not adopt the rules. "The concern [was that] if we don't teach kids how to hit in practice, they're going to get blown away in the games," said Stefan Duma of the School of Biomedical Engineering and Sciences and one of the co-authors of the study, in an interview with The New York Times. "This shows you can dramatically cut the amount of exposure in practice and have no more exposure during the games."
- A five-year study of head impacts in youth football, headed by Dr. Duma, also holds out the promise of generating data which can guide the development of improved practice strategies by Pop Warner and other national governing bodies, such as USA Football.
