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Transcript of 2018 Injury Data Results

The NFL released its most recent injury data on January 24, 2019. 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.

The following is a transcript of the briefing with reporters to discuss the data.


  • Jeff Miller, NFL Executive Vice President, Health and Safety Initiatives
  • Allen Sills, NFL Chief Medical Officer
  • Leigh Ann Curl, Head Team Orthopedic Surgeon, Baltimore Ravens, and President, NFL Physicians Society
  • Christina Mack, Senior Director of Epidemiology and Clinical Evidence, IQVIA


NEW YORK, NY - January 24, 2019

Jeff Miller: Thanks everybody for being here and to those on the phone, thanks for joining us. I am Jeff Miller with the NFL. Let me introduce our team here first and then I'll give a quick overview before we dive into the data. On my right is Dr. Christina Mack, she is an epidemiologist with a firm called IQVIA for the last seven years. They're a data analytics and injury surveillance firm that has provided injury data collection analysis for both the NFL and NFLPA. We work with them and the information is shared jointly as many of you know by now, most everything we do with health and safety is done collaboratively with the Player's Association. Injury data is one element of that, so Dr. Mack's firm is responsible for collecting and sorting the data, so she will be the one to walk you through the slides that we have.

Leigh Ann Curl, who is here on my left, has been with the Baltimore Ravens as their team orthopedist, head team orthopedist, for twenty years. She is also the president of the NFL's Physicians Society which is the group of, as the name suggests, physicians who work for NFL teams. She has been president for a year. And Dr. Allen Sills, who you know, is the Chief Medical Officer of the NFL. He has been here for two seasons and is an invaluable resource for us who work on health and safety issues. He will be able to provide significant commentary to a lot of the injury data and what we will be thinking about as we look forward to Combine.

Which is a segue for me to say this injury data is hot off the presses. I think Christina and her team have had this for four or five days and have been working day and night to collect it. It is not representative of the significant analysis we need to do between now and likely Combine when all of our committees meet, when we meet with the Competition Committee, when we meet with the Owner's Health and Safety Committee, when we meet with our subject matter experts, engineering experts and others and the Player's Association of course, to dive deeply into the data. So, you'll probably have a thousand questions around this and we will probably not be able to answer a lot of them. But we will get that information to you and Allen will talk about that a bit. But for now, this is all very high-level information that we feel comfortable with at this time because it's all we know. And we will share that with you. So, as it relates to some of the headline numbers, we had shared with you in October, that preseason concussions, in both practices and games, overall were down about 13%. That continued into the regular season. Practices and games in the regular season, we were down 29% this year. So, it is a significant decrease and one that we are pleased with. But, we are also more interested in why that decrease happened as opposed to what the number simply is. And as I suggested before, that is the certain work we need to roll up our sleeves and do between now and Combine. What effect did rule change have? What effect did helmet change have for the players who moved helmets? Allen will go into some of that. Is there behavior change going on field? Were there differences in the impact that caused concussions on the field? What plays and play types and player positions were most affected? I don't have that information today but, we will. And that is the sort of thing we need to do at Combine. And as we like to say, while we are pleased with the fact that the concussion numbers are down, and down significantly this year, when it comes to the health and safety of our players, there is no finish line. This is a multi-year process. We will keep at this. And we will try to figure out why these changes happened. We will try to figure out where we set goals and where there is still room for improvement. And I'm sure there are many of those too and we will take all of that into account when we meet with all of the experts over the next several weeks and intensively at Combine. So with that as background, I will turn it over to Christina first to go through some of the numbers. I know I do that because I give her the clicker.

Dr. Christina Mack: Thank you, Jeff. As Jeff said, my name is Christina Mack, I'm an epidemiologist, this is my seventh year working with the NFL, the NFLPA and the teams to run injury surveillance and analytics. So, we collect the data and the clinical information within the electronic medical record, like you're about to see, here are the top line surveillance numbers. Under all the numbers, are a large number of analytics that are ongoing and will culminate at the Combine.

So, the main message today from the data is that there was a substantial decrease in concussions this year, driven by a decrease in game concussions. In total, across preseason and regular season, practices and games, 214 concussions were reported which is 67 fewer than last year. We spoke after preseason about an observed 13% decrease in concussions in the preseason, 91 in 2017 compared to 79 in 2018. Which was driven again by this reduction in preseason game concussions. In preseason, there was not a drop in concussion in training camp or preseason practices, 45 in both years of the study, and that is going to remain a high focus for next year. So, the decrease that we observed in preseason continued into the regular season again, driven by less concussions in games. Overall, we observed a 29% decrease in concussions across the regular season and that mark in decrease in game concussions is what drove the overall decrease for the season. Those total numbers went from 281 last year to 214 this year.

From a team perspective, the meaning of that 29% decrease is that in 2018, a team experienced roughly one concussion in every four games whereas in 2017 that rate was closer to one concussion in every three games. So, the rate in 2017 was .7 concussions per game and then that dropped to .5 concussions per game in 2018.

And as Jeff Miller said, in the coming months, we are going to study the impact the various interventions had on the decrease in games. The other important piece to note here is that concussion detection efforts have been a high focus and have really ramped up over the past four years. With the athletic trainer spotters, the medical tents, the unaffiliated neurotrauma consultants on the sidelines and those efforts have increased our ability over the timeline of this slide to detect concussions. So, the data on this program and particularly the unaffiliated neurotrauma consultant program shows that those programs that can detect concussions are still firmly in place and that we are still taking a conservative approach to evaluating players and removing them from the game if needed. This season, between preseason and regular season games, unaffiliated neurotrauma consultants performed a total of 538 concussion evaluations. And the screenings were conservative. 75% of those players screened, ultimately didn't get diagnosed with a concussion. So, in the lifetime of this slide, you see the numbers going over year, there has kind of been this traditional sensitive approach to diagnosing concussions.

Dr. Allen Sills: Just to give some color, first all of thanks again to all of you being here, obviously we are excited and grateful about this decrease in concussions. Excited because we articulated that as a goal, if you remember this time last year, we talked about a call to action when we had that number of 281. And so, we put in place a concussion reduction strategy, which we will talk about, and we are excited to see the results of that. We are also grateful because that is the hard work of a lot of people. Certainly, foremost our players and coaching staffs and all of the teams that have embraced these changes and have rallied behind that goal. But then also the work from our team physicians, medical staffs, the NFL Player's Association, our engineers; this is an effort on behalf of a whole lot of people. I think at the same time as being excited and grateful, we remain very committed and challenged by the goal of driving this number down further. You know as Jeff Miller said, our commitment extends well beyond this year. We want this number to continue to go down. We are committed to further understanding why this number went down this year and how we can leverage that, and we are also challenged to make sure we share all of this information with other levels of play, other sports, so hopefully they can take advantage of what we learned and can implement it as well.

I have one other comment on something Christina just mentioned. The number went down, and this is a real and measured impact, it is not simply mathematical chance, she and her group have calculated that. But it is also not a reflection that we were any less vigilant in looking for concussions. In fact, as she mentioned, we did more negative concussion screenings than we have ever done. We did four screenings to detect one concussion or to say it in other terms, 75% of our screenings were negative. There was no concussion diagnosed. So, I think it reflects the fact that we remain really vigilant and committed to being as careful as we can to detect concussions. And I think Dr. Curl, as someone who has been on the sidelines for twenty years, can probably speak to that as well, as to what her observation has been today versus five years ago, ten years ago about the screening process.

Dr. Leigh Ann Curl: There is clearly a different threshold of sensitivity to pull players off to be evaluated. We routinely call some down from the eye in the sky, people on the sidelines, see something say something, so we have a very low threshold to take a player to the tent. The process has evolved, and it is very scripted now and standardized and we are confident that what happens in our stadium in Baltimore is what happens on the road. We expect the same availability and access to the unaffiliated UNCs that help us. And it is just, relatively speaking, despite the hype of the game, a smooth process and the players expect it now. A lot of players have seen this process for years, so they know when they come off, they are going to see us and go to the tent for an evaluation. It is a very smooth seamless process to have, it is a much more consistent process for the players and I think the players actually appreciate that. 

Sills: Something you might not be aware of, we brought everyone together again last summer, all of the people that are involved in concussion gameday care. The team physicians, the team athletic trainers, our Unaffiliated Neurotrauma Consultants, our spotters, our team neuro-psychologists, everybody came together for training again last summer to promote this idea that we are doing a standardized and a very comprehensive assessment. Again, I think that is shown in the numbers that we are doing so many screenings and that we set our threshold quite high for that.

Mack: So, ACL and MCL tear numbers are released in the next few slides. The takeaway for both ACL tears and MCL tears is that these injuries fluctuate across seasons but without meaningful increases and without showing a decrease. Here you see the incidence of ACL tears from 2012 to 2018. In 2018, overall 57 ACL tears were reported: 42 in games and 15 in practices across pre and regular season.

This is the same setup showing incidence of MCL tears. For MCLs, 131 MCL tears were reported, and that is a number that focuses on MCL tears that resulted in missed playing time. 117 in games, 14 in practices.

Sills: One thing that we charged over that we should just say for completion, both of these are knee ligament injuries, just to make sure. ACL, Anterior Cruciate Ligament and MCL, Medial Collateral Ligament.

Back to the concussion reduction plan and how it relates to this, you'll recall that there is sort of three pillars to that concussion reduction plan that we rolled out last year in March. And that was focused on education in the preseason, the rule changes involving use of helmet in the kickoff and better performing helmets. And so, obviously each of these was an emphasis, if you look at the preseason injuries, concussion numbers did go down from 91 to 79. But if you were looking closely, you would see that the preseason practice numbers were flat: 45 in 2017 and 45 in 2018. So that will remain a major focus for us.

I will tell you that we did a targeted discussion with seven clubs last year in the offseason. We took the seven clubs that had the highest number of preseason concussions in 2017 and we met with them and reviewed their data and talked about opportunities for improvement. Six of those seven clubs did see a decrease in preseason this year. So, we think that that is something significant and that is an approach we will try to scale out to all 32 teams.

We are also doing a video review for every one of those preseason concussions, so we can begin to understand them at a level of detail that we haven't before. So that will remain a major focus for us.

The rule changes, and the use of helmet in kickoff, I will speak about that in just a minute, but we are obviously continuing that analysis. We don't have that data for you today to say what was the impact, but we will have a lot more to say about that. Better performing helmets, I think is something we can talk about. So, you are familiar with this chart on the left showing the helmet testing done by the engineers from both the league and the Player's Association. You're also familiar that we grouped them last year into green, yellow and red with green being the highest performing. And if you look on the right, what you see is a very substantial change in behavior this year. We went from 41% of the players wearing the better performing helmets in 2017 to 74%. That is essentially 1/3 of the league that changed their helmets based on this data. And we think that is, first of all, enormously important but secondly reflects the collaboration and educational efforts on behalf of the Player's Association, the league, the teams, the equipment managers and the medical staff. So, we are really proud of that statistic and basically it shows that today, three out of four players in the league are wearing one of the better performing helmets. Also, you see on here that the percentage wearing the poorer performing helmets went from 17% in 2017 to 2% in 2018. And obviously that will be 0% next year because the reason that we had a little bit leftover was because there was a one-year clause stating that returning players could keep their helmets for one more year. That again is a very substantial number that we are grateful to see.

Leigh Ann, I don't know if you have a perspective being in the locker room and on the sideline, what you've seen with players and their choices of equipment around this data.

Curl: Every team has a list of players who wear the poor performing helmets, including those players who have had concussions. There was a meaningful focus on recognizing what the science was telling us and having the players adopt what they were doing, and I think it is a meaningful shift and the players appreciated that as well.

Sills: And obviously we will be repeating this testing and this analysis for the upcoming season to even further understand it. So, along the lines of what kinds of things we are going to do over the next few weeks, Jeff referenced we have a lot of work left to do, these are some of the things to look at; how many of the concussions, what percentage, were caused by helmet to helmet hits and did that go down compared to previous years? Has the mechanism of concussion changed? Did that play a role in this decrease, whether it was hitting the ground or hitting the shoulder, etc. We want to look at the kickoff play in a lot of detail and see how did the changes on that play affect not only concussion injury rates but also other injuries as well. Remember that for years the kickoff has been the most dangerous play for all injuries, not just concussions. So, we want to have a look at that. We will look at the frequency of the player lowering his head, which was the behavior we were trying to get at with the rule change. We will look at particular positions or plays and how their concussion rates may have been affected, and then at recovery time. So, all of these questions you see here are things that we will be looking at over the next few weeks and hope we will have answers to them for you by the time that we are at the Combine.

I think it is important to say we don't want to just stop here, not just for concussions but, for other injuries. Still statistically, the number one-time loss injuries in the league are lower extremities injuries. And so, we know that the burden on players is substantial. Things like hamstring, knee ligament injuries that you heard about, foot and ankle injuries. So, we are going to be putting a major emphasis on injury reduction strategies for those injuries this year. As Christina presented to you, those numbers are flat, so you can say that those numbers didn't go up but that also means that those numbers didn't go down. And we want to see them go down. We believe we can drive them down. So, our goal is to take this same data-driven approach that we have done with concussions and to look at those injuries. Understand them, characterize them, consider the equipment and consider the rule implications and see if we can make a difference there. So, some of the things that we will be looking at, we have a committee that has been looking on turf, analyzing different types of turf. Not just artificial versus natural but within those surface categories, what are the performance characteristics, what can we measure? How can we better engineer those with manufacturers and turf maintenance crews to look at the relationship to injury?

We've got a major project on cleats, you know for the past couple of years we've done these posters on cleats, Jennifer Langdon and her group are leading an effort to put identification tags on cleats, so we can actually track injury rates per cleat. So, that's something that we will have a lot more analysis to do, similar to what we've done with helmets.

We are also looking at things like the training regimen. How does the schedule across the year, not just during the season, but with offseason workouts and training camp, how do those affect these lower extremities injuries? We have a group working on that. And then the whole biomechanics of injury including the foot scanner project that you may be aware of, we've got a 3-D scanner of feet that we got going. So, each of these areas has a work group that is working on them. And I challenge those groups to bring us back a plan by the end of this year around injury reduction for those lower extremities injuries that are so prevalent.

Miller: Let me wrap it up and then we will take your questions. That is a little bit of a preview of things that we are going to be focused on next year. In addition to the lower extremity injury strategy, that Allen was offering, that is a multiyear effort, we aren't going to see dramatic changes in any one moment, there is a lot of work that needs to be done there and it is going to take time. At Super Bowl in a couple weeks we are going to have our usual 1st and Future competition, pitch competition, what is different about it this year, and we are really gratified by this effort, I think it is really interesting that we put out a data set; injuries, speeds of players, play types against the punt. And we asked a bunch of data analysts around the world on a platform called Kaggle, which is a Google company, to come up with ideas on how to make the play better. Actually, how to improve a play. We are unaware of any sports leagues that have actually gone to the fans and crowdsourced the play to try to improve it. So, we like the novelty of it but more importantly we like the results. And we have literally thousands of data analysts talking back and forth around the punt plays. People who clearly understand the game to those who are just coming at it for the first time. But, with the data set, they have a perspective. So anyway, we awarded four winners – which we'll introduce to whoever is in Atlanta to, and they're going to present their ideas on how to change the play for better. That will be shared with the Competition Committee and maybe they'll take some of it, maybe they won't. I don't know. But, it's our first effort in that regard.

But it really comes on the heels of the work we did on the kick-off play, which was a very similar analysis that we did in-house with our engineering consultants to take a look at where the injuries occurred, how they occurred, what the mechanisms were, what plays, what positions, what behaviors, were those players engaged in when they suffered those injuries – feedback to the competition committee and then the competition committee and all of their expertise goes about trying to change the plays for the better, which has been a great collaboration. The folks on the competition committee have been working closely with us for years. But, now that we are able to provide another level of information than we have before, their interest and their requests of us have ramped up and they have been really open minded and really thoughtful on how to use some of this, and the punt is the next example of it.

We'll announce this Spring at some point a big helmet challenge. We've been, as you know, working on our engineering roadmap for a couple years. We have now collected significant amounts of information about the injuries on field from a review of every concussion over the last three years, mapped against 150 different variables which is a substantial amount of information. We have developed finite element models which are digital versions of tools that entrepreneurs, academics, innovators can use to try and design the next generation of helmets and we've provided all those publicly. So, now, we are going to dangle an incentive against it of about $3,000,000 to people who can come up with new ideas to improve over what we currently have in helmets to improve protective equipment. It will take a while, it's a year and a half or so for the challenge, but we are going to start that this spring and provide all that information to a bunch of people to come up with the next design. And on that point, something that we haven't done before, let me just add one more quick thing around the helmet challenge which I think is interesting. This year, as you know we test helmets every year those that are being worn on field, we anticipate likely a record number of new helmet models to be introduced by the manufacturers – could be as many as 9 or 10. We think that that is an interesting and important point simply because we have been trying to create innovation in a space where there might not have been as much as we would have hoped. Based on the research and development that we're doing, that our engineers are doing, in conjunction and very close collaboration with the Player's Association, we are starting to see new models, new ideas, things tending towards position specific even, as manufacturers understand what impacts are causing what injuries even down to specific players, they are making adjustments to the models based on that. Little by little. This year, it seems like there will be a lot. We think that that is very promising.

Lastly, and this will roll out in the fall, some of you are already aware, we are going to put mouthguards with sensors on them on NFL players for the first time. So, these sensors which we have developed were tried on University of Virginia football team this past fall with positive results. Our engineering and the Player's Association engineering group like where we are going and so we are going to put them on about four teams, probably not all members of the team but some members of the team these mouthguard sensors that will measure the magnitude of the impacts they experience, the direction they come from including locational frequency, how often it happens, and we'll take a look at that data over time to sort of see how it teaches us more about the injury suffered on-field as well as protective design of equipment, as to how to better understand and characterize what happens on field and therefore how to better mitigate those impacts. It's not a diagnostic device, we are not diagnosing concussions based on these sensors and it is a trial. It is a pilot. This information will be used after the case by a bunch of engineers to take a look at and see what we can learn from it. But, again, it's both important from an innovation perspective and from a collaboration perspective, and we think long term, it's going to lead to even better designs for protective equipment and understanding of what happens on field. All for the betterment of the health and safety of our athletes. So, with that, happy to open it up to questions.

Reporter: Nothing was mentioned here with equipment about pads. What sort of work are you doing with pads? Shoulder pads? Pads that are required and even pads that are optional?

Miller: Shoulder pads is an early focus for us. It's not something that we have spent a tremendous amount of time and effort and work against. But, what is increasingly important, as we have tried to get the competition committee working with us, is trying to get the head out of the game. And so, if players are using their shoulder, leading with their shoulder more frequently, then shoulder pads come into play, and those have changed over the years. And I'm not sure that there is a great deal of understanding as to what their protective capabilities are for the player who is wearing them nor what the protection might be for the partner who they hit. So, when somebody is leading with their shoulder and they happen to hit an opposing player in their head, what is the impact of the protection of the individual striking player's shoulder against the helmet of the other player? We don't know. But, we do see shoulder to helmet impacts being a significant percentage of those that cause concussions. So, what does that all mean? Not just on the helmet side. But, on both sides. So, that's some work that engineering committee is doing again with our Player's Association but, it is early stage, so I don't have a lot to share with you at this point.

Reporter: You talked about putting sensors in the cleats. Is that going to be something you try to do with all cleats for all players or are you going to do a similar thing like with helmets where certain cleats rank too low for causing injuries and are not allowed to be worn?

Miller: It's a similar thing to what we've done with helmets. So, as one step back, we've been testing helmets in laboratory against a test that replicates what happens on field. And last year we were able to show that there is a correlation between how the helmets perform in the laboratory and what happens on field in terms of injuries. Not a perfect correlation, but, it is a suggestion of how they compare. And therefore, that led us to prohibit, with the Player's Association, a certain number of helmets that perform poorly in the laboratory and poorly on the field. Likewise, we test cleats in the laboratory against traction, against flexion, against other things that may cause injury. What we haven't done is be able to correlate what happens on field in terms of players who are suffering some of the injuries that Allen described earlier, versus how that cleat tested in the laboratory. If we understand what cleat every player is wearing, both those who suffer injury and those who don't, because the prevalence matters, then we will be able to see whether there is an association. That would mean either that we have to improve our laboratory testing if there isn't a correlation. Or, if there is, then we can start to talk about how we can encourage the manufacturing design changes and player adoption changes to try and drive down that injury rate, as well.

So, that seems like a couple years away or a little farther away than like the helmets you're doing kind of right now?

Miller: We are less mature in that space, as Allen described the strategy, it's not a today thing. It is a multi-year strategy. Where the helmets, we are a little more mature on that. But, it's an important element. If we know what cleats players are wearing and what injuries, they are suffering in those cleats and we know how they test in the laboratory we can begin to put the puzzle together to talk about how to improve it.

Sills: I think the bigger concept though is to view the cleats as a piece of protective equipment, the same way the helmet is. And not just as a fashion accessory, and I think that is an important point of where we are trying to get us to understand is that there are important safety considerations of the cleats, just like there is for the helmet.

Reporter: Following up on that, is there a point where you put sensors in? Is that something you're looking to track data, whether its game or practice, that would actually be in the footwear?

Miller: That is one of the approaches we are talking to. We spending time actively considering. And the tracking, it wouldn't track speed or anything like that. We have that in a GPS locator system in the shoulder pads. It would be to track what players are wearing when they suffer an injury and what they wear when they don't suffer an injury, so you would know in each case.

Reporter: Would it identify force, or any of those kinds of metrics?

Miller: No. Not currently, I could see where it would get there at some point. But, for right now it would be for a matter of identification.

Curl: Right now, there is no good way to know what shoe the player has on because some players will change shoes at the quarter or at the half and you don't know, it's hard to know what they were actually wearing when they got hurt sometimes.

Miller: The concept is, if you are going to understand the injury, you have got to understand everything about it, right? The play that it happened on, the equipment that was involved, the surface, so that's kind of that comprehensive picture of the injury that we are trying to get, to the same way we did for concussion.

Reporter: In the trial use of the mouth guards, does that indicate that there is some belief that this might help with concussion reduction and therefore you're trying this or is this just a sensory analysis type thing?

Miller: It is part of the larger engineering roadmap. It was something that was put in there when we originally designed the roadmap and the big concept is if you better understand the forces that cause the injury you can do more to intervene and prevent them. So, what we have done as we have been developing the sensor, the company has been developing the sensor, you know, with our investment, we have done a video review of all the concussion-causing hits. We've tried to replicate some of those, digitize them, and create video reconstructions of them, and those are proxies for understanding what happens on field. When you have the sensor in the mouthguard and its accurate, we will really know – what exactly are the forces? What exactly is the magnitude? What exactly is the direction? So, it's the level of understanding of detail around those hits, both that are injuries and those that aren't so that we can share that with the manufacturing community and we can start talking about some interventions to better improve the helmets more so than they even are now.

Reporter: Looking back at some past conference calls on this nature, a couple years ago I think you said that there were 5 game stoppages when there was just a single ATC booth spotter, that went up to 8 when you added the second. I'm curious, Jeff and Allen, if this year by adding that 3rd person, the other UNC in the booth, if that resulted in first, how many stoppages and what total?

Sills: John, we are looking up that number about stoppages right now. But it did increase this year. Now, I can't say that that is directly related to having the UNC in the booth because again, we continue to emphasize being very cautious to our ATC spotters and also encouraging them, with the same motto that we have told everyone which is, "If you see something, say something." So, there has been a big push on our end for education and we also send out a number of videos illustrating certain scenarios where we said, "We'd like you to stop the game in this scenario." So, the number did go up, but I don't know that it's solely related to the addition to the UNC.

Do you have the number? 12. So, 12 this year.

Reporter: Thank you. If I could follow up with a second question. The players who volunteer that they have a concussion without any other symptom or any other person pulling them aside for a check – are you keeping track of that as the 100% sole volunteer that said, 'I might be concussed.' And is that number going up and perhaps is responsible for some of the numbers rising?

Sills: We are keeping track of that, John. I will tell you that we put a renewed emphasis on being precise with that metric. So, our unaffiliated neurotrauma consultants on the sidelines enter in the exam and enter in injury information at the time of that exam on the sideline, in the tent or in the locker room if it's done there. So, this year we made a major effort of how exactly do we want to define players self-reporting? And that made that definition quite different than what we've used in the past. With that being said we saw a really robust number, Dr. Mack, you may want to talk if you have that number, I don't know if you have that number at your fingertips.

Mack: Sure. So, of the concussed players that the UNCs evaluated, 40% of them had some component of self-report whether it was self-report alone or self-report in tandem with another player or with a coach or with a physician. As Dr. Sills said, the definition of self-report this year was that there had to have been no question. Any case where there was no question that if the player needed to be evaluated – then that couldn't be a self-report. It had to be where the player actually could self-report. So, in those cases when the player had a concussion, 40% of the time there was some self-report component.

Sills: I think that confirms, John, what we were saying anecdotally, maybe I'd ask Dr. Curl, the perception of those of us that spend time on the sidelines is that players continue to understand the importance of identifying symptoms that they have and to readily report those symptoms and that's a major change that's happened over the last 5 or 10 years. Dr. Curl may want to comment on that.

Curl: I think there's, in general, less resistance to being pulled aside for a diagnosis, or an evaluation I should say. I think players are more free to come over and be checked out. I can think of circumstances where you know certain times in a game you might not want to do it. But, I think in general the players are much more accepting and willing to be recognized, whether its self-report be told they need to be evaluated and go off and get evaluated. It's just you tell them, "Okay, we are going to the tent," and they just start walking that way. They know the process and the UNCs there, and they know they are getting seen by two people and it's a collaborative effort and I do think it's not as much friction as there used to be to getting evaluated.

Reporter: Regarding mouth guard sensors, a couple years ago there was a push to do mouth sensor testing and that was abandoned because of concerns the technology was not accurate enough. What's changed in the technology since then?

Miller: It's been a while and there are others who are developing sensors and we've tested a few, the company we are working with designed one that we are piloting, as I mentioned. The University of Virginia testing in the laboratory to sort of determine the likelihood that there would be false positives or false negatives for that matter and seeing whether or not it experiences, with the degree of certainty that we discussed, and that the engineering group – we have engineers on both sides, both the ones that we have employed and the players association and are very pleased with the progress of it in terms of accuracy.

Reporter: What is the name of the company?

Miller: Let me get back to you on that. I know the name of the company, I'm not sure that contractually I am able to tell you. I have to check with that.

Sills: Part of the challenge with the helmet-based sensors that you're referring to is there's separation between that and what the brain actually sees, right? The helmet is made to deform or move because what you're trying to get at with the sensors and understanding what forces are actually getting transmitted to the brain, right? So, by putting a sensor on the helmet, while that is close to the brain, the helmet actually may dissipate a fair bit of that force or it may be traveling in a different direction, so you may not be getting as accurate of a reading. It's a little bit like putting a sensor on the bumper of your car and trying to measure what force did your liver get in a collision, right? There's just a geographic separation and there's energy absorption that goes on in the materials. So, as a neurosurgeon I lobbied to put sensors in the brain, but that got voted down for some reason that I can't understand. That was a joke. But, the idea with the mouthguard, it's as close to the organ of interest that you can get, it's going to give you more accurate data than one that's based on the energy absorption of material.

Reporter: On the 9 or 10 new helmet models, do you anticipate anything different in terms of the materials, maybe something from the crowd source competition that have been introduced previously?

Miller: I don't know. The incumbent manufacturers, Riddell, Schutt, others have worked on things like 3D scanning of player heads, right? To improve fit. I've heard, although I don't know, that there are some other interior liner material advances. But, until we get our hands on them and test them, I'm probably just speculating a bit.

Reporter: Dr. Sills, you mentioned the gathering you had last summer, essentially everybody involved in concussion research. Are you planning that again, and if so, are you expanding it in anyway? Can it even be expanded?

Sills: Well, education for everyone involved in the concussion care chain is an ongoing process. Again, that's not something we do once a year, that's something we do throughout the course of the season. We continuously look at how we can improve the level of understanding and cooperation and collaboration among all the different care providers. So, we haven't made a determination yet. Some of that will depend on any changes in the protocol that are made by the head, neck, and spine committee at the Combine meeting. So, depending on how they move the protocol and what we learn from the more in-depth analysis, we'll make a decision on what's the most effective way. But, the short answer is yes, we will continue our educational efforts and our efforts to promote this spirit of collegiality that is existing on the sideline. Again, I think Dr. Curl can testify to this, you now have an atmosphere where everybody is invested the same exact goal which is to be as cautious as we can be and to capture all the players who might be injured and so that's true for the team personnel, for the unaffiliated personnel, for our spotters and frankly our game officials. One component last year was, I went and spoke with the game officials and we had to empower them to stop the game and bring players off for evaluation which you've seen happen. So, recognition of potentially injured players is everybody's business and we'll continue those educational efforts.