Experts Focused on Health and Safety
Each year during the NFL Scouting Combine in Indianapolis—while college prospects undergo a demanding four-day evaluation, including extensive medical exams and testing by all 32 teams—the NFL medical committees meet to review the previous season and begin their off-season work to prepare for the next year.
Each NFL medical committee brings together top medical and scientific advisors across a variety of disciplines. They analyze injury data from the previous season, discuss statistical trends and identify issues that need further examination or research. Representatives from the NFL Players Association (NFLPA) participate on each medical committee.
Based on their analysis, the committees offer recommendations to try to advance player safety by continually seeking to improve the prevention, diagnosis and treatment of injuries.
"The Combine work is intense but it's also exciting. It's a rigorous review of science and clinical medicine for our patients, which are the players." said Dr. Rich Ellenbogen, a neurosurgeon and professor and chairman of the Department of Neurological Surgeries at the University of Washington. He is also the former co-chairman of the NFL Head, Neck and Spine Committee.
"We're looking at how to make players safer on the field, players safer off the field, what research needs to be done," he said, "and how can we advocate to make all sports safer."
Prevention, Diagnosis and Treatment
Across each committee, work at the Combine ranges from examining the latest scientific research to preventing and detecting injuries.
The neurosurgeons, physicians and scientists on the NFL Head, Neck and Spine Committee focus on "the best treatment and management for players that get concussions," said Dr. Ellenbogen. The committee also shares with the Competition Committee ideas and proposals to adjust rules to seek to reduce the types of hits associated with concussions.
On the orthopaedic side, the NFL Musculoskeletal Committee focuses on fractures, muscle strains and ligament sprains of the foot, ankle, leg, shoulder, trunk, elbow and wrist.
For fourteen years, orthopaedic surgeon Dr. Robert Anderson has been advising the NFL on foot and ankle injuries. As co-chairman of the NFL Musculoskeletal Committee, he said the NFL brings in statisticians, epidemiologists, researchers, biomedical engineers and clinicians who span specific areas of orthopaedics—"everybody we can think of that may help solve some of the problems that we have right now and then how to prevent those injuries."
Dr. Andrew Tucker, a primary care physician who specializes in sports medicine, is head team physician for the Baltimore Ravens. He chairs the NFL General Medical Committee, "a committee related to the health and safety of the active NFL player, all things non-orthopaedic," he said. "It covers cardiac screening and cardiac health, infectious disease, heat and environmental injury and risk, mental health."
The goal is to "give our athletic trainers and our medical staffs the best and most cutting edge information, and how it relates to taking care of our player patients," he said.
Analyzing Injury Data
Throughout the year, comprehensive NFL player injury data is compiled and analyzed by IQVIA (formerly QuintilesIMS), an independent, third-party company. Results are then shared with the NFL, the NFL Players Association, and the NFL medical and football committees.
The committees' efforts at the Combine are "the culmination of a season's worth of analytics," said Dr. Christina Mack, director of epidemiology and health outcomes at IQVIA (formerly QuintilesIMS).
"The medical committee meetings that are happening at the Combine are very comprehensive in terms of topics," she said. "That adds a richness to what we're able to glean and learn from the data. We're understanding the setting and the context around those injuries."
Guided by the experts at IQVIA (formerly QuintilesIMS), the committee members look for trends in how, where and when injuries happen, such as injuries reported in the preseason and the regular season, during specific plays like kickoff, and during Thursday night games versus Sunday and Monday games. Their analysis also covers trends in all injuries impacting players, including concussions and ACL/MCL tears.
Shaping Policies, Rules and Protocols
Based on the collaborative work beginning at Combine and throughout the year, the committees form recommendations that are shared with the NFL Competition Committee about potential changes to policies, rules, medical protocols and practices.
These recommendations are shaped by NFLPA representatives, including NFLPA medical director Dr. Thom Mayer, who provide key insights on player safety.
Since 2002, the NFL has made 50 rules changes intended to eliminate potentially dangerous tactics—plays like horse collar tackles, peel back blocks, clipping and chop blocks—and reduce the risk of injuries.
This year's analysis during Combine helped lead the Competition Committee to propose a number of new rules changes adopted by clubs at the Annual League meeting in March.
The new changes included giving a receiver running a pass route defenseless player protection and prohibiting crackback blocks by a backfield player who is in motion. Clubs also agreed on certain changes to the way games are officiated, including points of emphasis on forcible hits to the quarterback and flagrant hits.
Unique Collaboration and an Important Job
"It's all about improving the game with science and making it hopefully safer," said Dr. Mike Coughlin, an orthopaedic surgeon and co-chairman of the NFL Musculoskeletal Foot and Ankle Subcommittee. "The common goal is just to prevent injuries or to minimize them or to reduce the severity."
For Dr. Robin West, an orthopaedic surgeon and head team physician for the Washington Redskins, 2017 was her fourteenth Combine. "We all get together and present our research or talk about cases," she said, "so we all learn from each other."
Dr. West said this unique kind of collaboration has been of great benefit to the players. "The culture of safety in the NFL continues to grow and it gets stronger and stronger," she said.
"It's a really important job because our goal is to do it better, do it smarter and make the game safer," said Dr. Rich Ellenbogen.
The NFL Medical Committee Structure
To further strengthen its efforts, the NFL reconfigured its medical committee structure in 2016. All committees are now organized under an overarching Health and Safety Committee, which brings together the chairmen of the Head, Neck and Spine Committee the Musculoskeletal Committee and the General Medical Committee, plus representatives from the NFL Players Association (NFLPA), the National Football League Physicians Society (NFLPS) and the Professional Football Athletic Trainers Society (PFATS). The Health and Safety Committee is designed to encourage representatives from every discipline to collaborate regularly, share experiences and jointly prioritize research projects as they seek to make the game safer.
During the Combine and throughout the year, additional groups meet to discuss and plan their health and safety efforts, including the Owners' Health and Safety Advisory Committee, the NFL Research and Innovation Advisory Panel, the NFL Engineering Committee, the Scientific Advisory Board (SAB), the and the Board of Directors for Football Research, Inc. (FRI). The NFLPS and PFATS also hold their own conferences and meetings at the Combine for club physicians and athletic trainers.
For more information about the NFL medical committees and organizational structure, please visit: https://www.playsmartplaysafe.com/resource/nfl-medical-committees-overview/