The NFL revised its concussion protocol in the wake of a controversy surrounding Dolphins quarterback Tua Tagovailoa. Here’s how it works.
The NFL saw its fewest number of concussions in the preseason since tracking started in 2015.
There were 44 concussions in practices and games, a decrease of about 24% from last year.
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“The reason for that change has certainly to do with changes to rules, changes to equipment, including the Guardian Cap, as well as a host of other efforts we’ve made over the years to drive the numbers down,” said Jeff Miller, the NFL executive vice president overseeing player health and safety.
The league’s revamped kickoff rule led to fewer injuries overall but there were some concussions on the play.
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“We saw a couple more concussions on the dynamic kickoff than we thought we would see,” Miller said. “We haven’t seen any concussions in the first three weeks of the dynamic kickoff in the regular season.”
Nearly 99% of players wore top-performing helmets, including more than 250 players wearing helmets that the league says provide as much — and in some cases more — protection than a helmet paired with a Guardian Cap.
There was a nearly 50% reduction in concussions in the preseason among players wearing the Guardian Cap in mandated sessions versus the pre-mandate average.
The injuries were back in the forefront when Dolphins quarterback Tua Tagovailoa sustained his fourth diagnosed concussion in five years during Week 2.
"I know that he is seeing top experts,” NFL chief medical officer Dr. Allen Sills said.
Sills said the league has no role in Tagovailoa's future plans. If doctors clear him to play, it's Tagovailoa's decision.
“Patient autonomy and medical decision-making really matters,” Sills said. “And I think that’s what we have to recognize goes on with our concussion protocol as well. Ultimately when patients make decisions about considering their careers, it has to reflect that autonomy that’s generated from discussions with medical experts giving them best medical advice.”
Sills, a neurosurgeon who has led the NFL's push to strengthen its concussion guidelines, said there's no “detailed formula” that predicts future risk for players.
“It’s not like we can put in your number of concussions and how long between them and your age and some unusual constant or Avogadro’s number that always seemed to be in freshman chemistry somehow, and come up with a risk,” Sills said. “It just doesn’t work that way. So what we end up having to do is look at the totality of the patient’s experience, how many concussions, the interval between those concussions, some about duration of symptoms after each concussion, and then very much the patient’s voice about where they are in their journey, their career, their age and things of that nature.
“And from that, we try as medical professionals to provide our best guess. But that’s really what it is, is a guess at what is someone’s future risk of concussion.”
Lower-extremity strains were down by 27% in 2024 compared to the 2021 preseason, the year before the acclimation period was introduced.
“While there is no finish line in our efforts to make the game safer, the injury data from this preseason is an example of how the league’s deliberate approach to player safety continues to deliver results,” Sills said. “We’re committed to building a culture of safety around the game, and this preseason was another positive step in that direction.”
