The NFL released its most recent preseason injury data on October 15, 2019 during the Fall League Meeting. The injury data is compiled and analyzed by IQVIA (formerly Quintiles), an independent third-party company retained by the NFL. For more information, see the injury data page.

NFL CHIEF MEDICAL OFFICER DR. ALLEN SILLS AND NFL EXECUTIVE VICE PRESIDENT OF PLAYER HEALTH AND SAFETY INNOVATIONS JEFF MILLER: PRESS BRIEFING

2019 FALL LEAGUE MEETING – FORT LAUDERDALE, FL

OCTOBER 15, 2019

Jeff Miller: Around this time every year, we take a look at preseason numbers and some other developments in the health and safety space. And we talked about some of the helmet adoption numbers, preseason injuries and mental health – which has been a priority for us during this offseason – so we’ll walk you through that now. On helmet adoption numbers, which is something that we’ve obviously spent a lot of time thinking and working on over the past couple of years, including in this offseason, we’re really pleased with where we are in terms of the players adopting the best performing helmets. Credit to the players, to the Players Association, to our equipment managers, and training staff. Two years ago, in 2017 – just a few statistics – we had about a 41% adoption rate of the green – or the best performing helmets. Last year, by Week 17, that number had jumped to 74%, so that was a significant increase. By Week 5 this year, all but 13 players across the NFL were wearing the green – or best-performing helmets, so that’s 99%. Those 13—just for clarification—are wearing yellow-performing helmets which are still permissible. None of the players were in those that are are prohibited.  So again, credit to a lot of people for making those differences. Those helmets perform better in laboratory testing where we do see a correlation with on-field injuries, and we think that that’s another step towards player safety that we’re proud of and I’m proud of the work that we’re doing with the Players Association. Allen will give an update on the injury statistics.

Dr. Allen Sills: Thanks Jeff. So, we always, as you know, at this time of year start to look back at our preseason injury numbers. We’ll start with concussions. I would say that overall the story there – it shows is that we still have work to do. We like to say that progress in health and safety is not always linear, and I think this is illustrated by the preseason. So, we did see a significant decrease in preseason practice concussions. They went down from 45 in 2018 down to 30 this year. We’re really pleased about that. We think that reflects the emphasis we placed on that. We obviously had lots of discussions with clubs and with coaches and really put an emphasis on that. You know that Troy and this group worked on prohibiting certain drills and so we think all those factors played a role. At the same time, concussions went up in preseason games. They went up to total of 49 this year. And so, the overall number of concussions in the preseason was flat. It was 79 in 2018 and was 79 in 2019, if you account for practices and games. So down in practices, up in games this year. Obviously, we will continue to do a lot of drill down work on exactly what’s driving that in games. We’re looking at who’s injured, how they were injured, what type of place, did they eventually make the roster, and how many years of experience they have. We’ve already got some preliminary work on that. I think we can say that it looks like it’s disproportionately rookie and first-year players who are suffering those concussions both in practices and in games, and in fact, a lot of those players who’ve been injured in games with concussions don’t end up making the roster. So that’s something we have more work to do. Jeff, you may want to add some color on that point.

Miller: Sure, we took a look at who is suffering the injuries as opposed to just the mechanisms of those injuries. We saw a couple of interesting points as Allen articulated. We’re seeing a move or trend towards players who don’t make the rosters suffering a disproportionate number of the injuries. As an example, five years ago when you started tracking some of these statistics, if you made the roster or you didn’t make the roster, your relative rate of concussion was almost exactly the same. Five years later in 2019, players who did not make the roster had twice the rate of concussion in practices and games, as players who did make the roster. Now there’s an obvious correlation there between playing time. The preceding players who don’t make the roster are playing an increased number of snaps during preseason games, so it makes sense that they’re going to suffer some more injuries, but that was one of the insights that was gleaned from it, Allen talked a little bit about some of the rookie or first year players suffering a greater number of injuries or potentially being involved in collisions that caused more injuries so that’s another point of information that we’re going to continue to track.

Sills: So, we’ll continue to do a lot more analysis on the preseason concussion numbers in both practices and games, but that’s where we are now. You also know that we’re doing a lot of work on lower extremity injuries and really targeted that because it remains the highest burden of injuries affecting the NFL with the most time loss. So, we’re just at our infancy in a major effort with regard to lower extremity injuries – again targeting those injuries that show up, not only at preseason training camp but throughout the year. So, we’re doing work, for example, tracking all cleats this year. Just like we’ve done with helmets, we want to be able to track exactly what cleats players are wearing so we can calculate the injury rates per cleat and understand which cleats may offer a better degree of safety for our players. We’re certainly doing a lot of work on turf systems and trying to again look at both natural surfaces and artificial surfaces and correlate injury rates with those so we can learn recommendations there. And then we’re looking at the timing and the and the acclimation period of how the training camps are done and how that may affect soft tissue injury. So, all of that work is ongoing, and we’ll hope to have a lot more to tell you about that come Combine. For the preseason, the numbers around some of our injuries that we track, ACL injuries, did go down this year; in the preseason there were 16 this year, compared to 28 last year, and MCL tears were also down – 29 this year compared to 36. So again, I don’t want to represent that reflects the results of those efforts, as I told you we’re still just starting the analysis on that work. But those are the numbers as far as some of the soft tissue injuries that we’re tracking. Obviously another major injury really emphasized are hamstring injuries because we know again we have a big spike of those early in training camp this preseason, so we’re really targeting that with some work as well.

Question: Has there been a resolution in the study with the NFLPA of Sterling Shepherd’s concussion from a few weeks ago that was under review and he was allowed back in the game?

Sills: It’s still really out of our domain and with our Management Council discussion between the Players Association and the league, so we’ll follow up and get you an answer.

Question: A couple of weeks ago Shepherd had another concussion where his helmet kind of went sideways on a tackle – he was allowed to go back in the game and then missed the following week’s game. Can you kind of go over what happened there, and does that point to the complexities of just dealing with this problem?

Sills: Let me speak generally rather than the individual player because again some of that is still under review. But you know we will never detect 100% of concussions on game day. And that’s because it is a difficult injury to diagnose, but also because it presents in a delayed fashion sometimes. Sometimes players don’t have any symptoms at the time of injury, but they may show up on a delayed basis either a few hours or even a day later. So, part of our concussion protocol is that every player who gets a concussion evaluation on Sunday gets a follow-up examination on Monday, just for that reason. That’s even with all negative evaluations. So, all of the negative evaluations we do on Sunday come back in and get a follow up exam, the day after the game. So, I would just say to you that we track that very carefully. But in medicine, we always talk about that we almost have no tests that are 100% effective at screening conditions and so I think it reflects that reality and also just the evolving nature that is injuries sometimes. Fortunately, it’s a very low number that shows up on delayed basis, but it does happen.

Question: It’s been a couple of weeks now, it feels like a million years ago, but the Antonio Brown helmet situation. Did anything come out with that, either increased awareness, to how many players reached out, or did you guys come up with any conclusions on that saga kind of looking back at it?

Miller: I think I said this at the time – I’m not sure there was more of a silver lining possible from a dynamic like that than to raise awareness around the work that we’re doing with the Players Association in terms of trying to move players to better performing helmets. The manufacturers are improving the quality of the helmets that they are producing. Our research that we’re sharing with them is going into that. But the public education and awareness around the importance of the helmet and the willingness of players to change helmets I think probably reached the pitch around that, back and forth, around the individual player. Now, let me also say a lot of players changed helmets over the past year. In 2018, half of the league changed helmets. I mentioned the stats, this year, about players moving into from yellow or from red into green performing helmets. That’s not an easy switch. And I think our work with the Players Association and the players themselves highlighted that. And so, it is credit to a lot of people to take a look at a piece of protective equipment that they normally may have gone years wearing the same particular one, and saying okay, you know what, there’s another way to take a look at this. So, for us, to raise awareness was positive, but it’s also an important contribution on the player side, really importantly in good partnership between the league and the PA to get to the place where we’re now working with them together. And as I suggested this will be a dynamic process. Next year, there will be more, better helmets and the year after that that there will be more, better helmets. And hopefully the ones that are the best rated ones now someday aren’t going to be, and players will continue to move into those that are not yet produced.

Question: Within the preseason injury data, how did it break down across the four weeks of preseason? Did you see them clustered and beginning, the end, and any conclusions you might draw from that?

Miller: Yeah, you take a look at practices – every year, we see the most injuries, the most concussions in the first couple of weeks of training camp before you even get to playing games. The larger roster sizes, any number of other contributing factors, and that is the reason that Allen is putting together a lot of these injury prevention programs – understanding soft tissue injuries, looking at hamstrings, looking at the drills that Troy is working on, and the clubs around those that provide the highest vulnerability or risk for players. But interestingly — and this goes to the point about some of the younger players or some of the players who didn’t make the roster this year suffering a disproportionate number of the injuries – is what in preseason we’ve screened for. We saw a substantial uptake in the number of concussions year-over-year and could there be a correlation between the amount of time the players who are making the roster are getting in those games? Maybe. It’s one year of data, and we always hesitate to jump to conclusions based on one small sample size. Nevertheless, those numbers jumped out of the data, and we want to take a look at those and think more about them. So that’s little bit of color on some of the injuries and when they were occurring.

Question: What’s the next step with that, as far as those concussions late in preseason and to try and help that situation?

Sills: Yeah, I mean I think we continue to attack the way we have before. We obviously want to get players in the best performing helmets, but we also continue to emphasize the style of play that goes into this and part of that’s looking into those solutions in games and determining those factors, right, about who’s being injured and on what type of play. So, we have a very close working relationship with the Competition Committee but also with clubs and coaches, and I think as they continue to work with players and teach these techniques, we hope that will change. I think some of it is, also as Jeff mentioned, when you have new players that are acclimating to our rules and our styles of contact with what’s allowable, there’s ongoing work to be done there.

Question: A couple of years ago, it was required the players had to put their pads over their knees. They had to have those pads over their knees. Is that rule still in effect? Because I noticed a number of DBs and sweep position players, receivers and DBs, they just have them up. And some running backs, so like Frank Gore or somebody put them on their lower thighs. What is the league’s take on that, and do you try and convince the players to keep wearing them?

Sills: I think one of the things we’re trying to do with all protective equipment is really understand what it does and doesn’t do and what is actually protective and important. And that’s what we’ve done in helmets, in terms of developing these ranking systems. We’re actually doing that now with shoulder pads, for example. We’ve got a major effort going there. So, I think we will continue to look at all pieces of protective equipment in that way. I’m certainly not the best person to speak about our rules in terms of what we enforce with uniforms. But I think to the larger point is that players respond just as they have with the helmets to the data. And so, when we showed the players and the Players Association the data about the helmets and how much how much helmet choice matters with injuries, they’re very quick to adopt that, so I think that’s the model for what we will continue to do.

Question: There’s a lot of focus on the ejections, the disqualifications, in part of the emphasis of the use of helmets. Obviously, the Vontaze Burfict suspension got a lot of attention. League-wide, I don’t know if you have any way of quantifying this, but are you seeing changes in the behavior? In other words, are there fewer of those types of hits happening, even though we pay attention to the ones that do?

Sills: Yeah, that’s something that we track very closely. So, with our engineers, we look at video, again of not only injury-causing and concussion plays, but also samples of all impacts. And then one of the other things that we’re doing this year is we have mouthguard sensors you know in four of our clubs as a pilot program. So, we also can track the degree of head impacts in practices and games. So, the answer to your question is we’re doing that, we don’t have a big enough sample size yet to quantify it, but we certainly look at is the behavior changing, not only on the injury-causing plays, but really overall? And we’ll have a lot more data to say on that come the time of the Combine.

Okay, thank you very much.

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