Data-Driven Gradual Preseason Practice Acclimation Ramp Reduces Lower Extremity Strains in the National Football League.

BackgroundIn the U.S. National Football League (NFL), approximately 1 in 4 players sustains a lower extremity (LEX) strain each season. Nearly 20% occur in the ~2-week period of Training Camp...

BackgroundLower extremity (LEX) strains (hamstring, quadriceps, adductor, and calf strains) are among the most common injuries in sports.ObjectiveDescribe the incidence of LEX strains in professional American football.DesignDescriptive epidemiological study.SettingU.S. National...

The National Football League (NFL) seems nearly omnipresent today in the United States. Even people who are not football fans know the team names and recognize the star players. That was certainly not the case one hundred years ago when the league was founded at a car dealership in Canton, Ohio. How this change occurred is the story that Richard C. Crepeau tells in NFL Football: A History of America's New National Pastime. Originally published in 2014, the University of Illinois Press issued this revised edition in 2020 to coincide with the NFL's centennial. The author has expanded a couple of chapters from the previous edition and added a new chapter.The book is divided into three sections: “The Formative Years,” “The Rozelle Era,” and “The New NFL.” Within each section, chapters are often thematic, which occasionally means there is some repetitiveness. The first section examines the birth of professional American football in the 1890s and its slow growth through the early decades of the twentieth century. Initially centered in the factory and mill towns of the Ohio Valley, professional football developed as a game to entertain the working class on Sundays. By 1920, team owners decided to create an organization, the American Professional Football Association, the forerunner of the NFL. The league's first decade was rocky; few teams survived into the 1930s. (An excellent appendix lists all NFL franchises by the year they were founded, including those that folded.) Crepeau moves through the NFL's formative years quickly. The league's founding and first decade are covered in about thirteen pages. The author then summarizes the next decade and a half (1930‒45) in twelve pages. This is mostly a work of synthesis, so Crepeau cannot be blamed if the literature on early professional football and the first several decades of the NFL is thin. But readers hoping for more on the formative years will be disappointed.Crepeau begins to hit his stride by the third chapter, which examines the late 1940s and 1950s. In this chapter, some important themes emerge—the NFL as a business enterprise, the reoccurrence of labor disputes, race and racism in the league, and the role of television in shaping the sport. These themes are continued into Part 2, which looks at what Crepeau calls “The Rozelle Era.” This is the book's longest section, and it forms the core of the book. In this middle section, chapters follow a general chronology but are also organized thematically. Chapters 4 and 5 examine the rise of professional football as a major cultural phenomenon in the 1960s, as well as the NFL's dispute and eventual merger with the American Football League (AFL). Television, of course, played a major role in propelling professional football to the forefront of American culture. As Crepeau notes, “The landscape of the NFL changed permanently with the coming of television, the AFL, and the commodification of nearly everything” (61). Thanks to the game's seemingly made-for-television controlled violence and drama, Crepeau argues, by the end of the 1960s, “football was clearly the national pastime” (90). In Chapter 6, the author takes a deep dive into television contracts and the ever-increasing amounts of money that they brought to the league. After discussing expansion, battles over team moves, and the league's handling of various publicity problems (Commissioner Pete Rozelle's specialty) in Chapters 7 and 8, Crepeau turns to labor disputes in Chapter 9. His coverage of the formation and growth of the NFL Players Association (NFLPA), as well as the three major strikes of the 1970s and 1980s, is excellent and probably makes Chapter 9 the strongest one in the book.Section 3 begins with the rise of Paul Tagliabue as the new commissioner following Rozelle's retirement, and the subsequent chapters focus on Roger Goodell's tenure as commissioner. Although Crepeau does not ignore social and cultural issues in the book's concluding section, at times, it comes across as largely an institutional history of the league from 1990 to the present, with the commissioners—Tagliabue and then Goodell—as the central actors. The author devotes two pages, for instance, to Goodell's handling of Baltimore Ravens running back Ray Rice's assault of his fiancée in 2014; the emphasis is on Goodell, not on domestic violence. The final chapter examines the Super Bowl as America's gaudy new national holiday.Creapeau's book examines the NFL as a business and a cultural phenomenon. It succeeds on both accounts. Anyone looking for a short overview of the NFL's meteoric rise to America's national pastime should begin with Crepeau's book.

During December 2021, the United States experienced a surge in COVID-19 cases, coinciding with predominance of the SARS-CoV-2 B.1.1.529 (Omicron) variant (1). During this surge, the National Football League (NFL) and NFL Players Association (NFLPA) adjusted their protocols for test-to-release from COVID-19 isolation on December 16, 2021, based on analytic assessments of their 2021 test-to-release data. Fully vaccinated* persons with COVID-19 were permitted to return to work once they were asymptomatic or fever-free and experiencing improving symptoms for ≥24 hours, and after two negative or high cycle-threshold (Ct) results (Ct≥35) from either of two reverse transcription-polymerase chain reaction (RT-PCR) tests† (2). This report describes data from NFL's SARS-CoV-2 testing program (3) and time to first negative or Ct≥35 result based on serial COVID-19 patient testing during isolation. Among this occupational cohort of 173 fully vaccinated adults with confirmed COVID-19 during December 14-19, 2021, a period of Omicron variant predominance, 46% received negative test results or had a subsequent RT-PCR test result with a Ct≥35 by day 6 postdiagnosis (i.e., concluding 5 days of isolation) and 84% before day 10. The proportion of persons with positive test results decreased with time, with approximately one half receiving positive RT-PCR test results after postdiagnosis day 5. Although this test result does not necessarily mean these persons are infectious (RT-PCR tests might continue to return positive results long after an initial positive result) (4), these findings indicate that persons with COVID-19 should continue taking precautions, including correct and consistent mask use, for a full 10 days after symptom onset or initial positive test result if they are asymptomatic.

The present research analyzes the attendance of individuals at a National Football League (NFL) training camp, comparing attendees within an 80-mile radius around the training camp with attendees from the NFL team's city who drove 100–140 miles to attend the training camp. Over 1,700 training camp attendees were surveyed. The results indicate that training camp attendees from the local region and those from the NFL city were found to be significantly different in terms of age, use of information sources, and previous attendance at the training camp. Proximity to the training camp location was the most important influence on the decision to attend the training camp. However, the data also suggest that proximity to the NFL city (team identification) was also an important influence on attendance.

Background:Kickoffs in the National Football League (NFL) are historically one of the most dangerous plays during an NFL game, with high levels of injuries. In 2024, the NFL introduced new rules aimed at reducing injuries during kickoffs, enhancing player safety, and increasing the frequency of kick returns.Purpose:To evaluate whether the NFL kickoff rule changes in 2024 had any effect on the incidence of injuries, particularly with a focus on concussions.Study Design:Descriptive epidemiology study.Methods:Injuries on kickoffs were identified for the 2022, 2023, and 2024 NFL seasons using the transcribed game book for each game on the official NFL website. Injury type was confirmed using the injury report on each team's website for the following week. If an injury was unreported on the subsequent injury report, it was listed as an unspecified injury. Injuries were defined as neuromusculoskeletal complaints documented in the game book for kickoffs and confirmed in the subsequent week's injury report. The injury rate was calculated annually for each injury category by analyzing injury incidence relative to the number of kickoffs and returns, with each analyzed separately. The incidence rate ratio (IRR) was calculated by dividing the IRR of one season by that of another season. Also, 95% CIs for the IRR were calculated, and P values were determined using the exact Poisson method.Results:This epidemiological study found that a comparison of the 2024 versus 2022 season showed a statistically significant increase in the overall number of injuries (IRR, 1.10 [95% CI, 1.08-1.11]); P < .001), upper extremity injuries (IRR, 6.74 [95% CI, 6.30-7.21]; P < .001]), and lower extremity injuries (IRR, 2.20 [95% CI, 2.14-2.26]; P < .001), when analyzed by the number of kickoffs. This study found that a comparison of the 2024 versus 2022 season showed a statistically significant increase in the overall number of injuries (IRR, 1.25 [95% CI, 1.23-1.27]; P < .001), upper extremity injuries (IRR, 7.69 [95% CI, 7.20-8.23]; P < .001), and lower extremity injuries (IRR, 2.51 [95% CI, 2.44-2.58]; P < .001), when analyzed by the number of returns. However, when comparing the 2024 and 2022 NFL seasons, 2024 saw a statistically significant decrease in the incidence of concussions when analyzed by both kickoffs (IRR, 0.77 [95% CI, 0.74-0.80]; P < .001) and returns (IRR, 0.88 [95% CI, 0.84-0.92]; P < .001). When compared with the 2023 NFL season, the 2024 NFL season showed a statistically significant rise in overall injuries (IRR, 1.59 [95% CI, 1.56-1.61]; P < .001), lower extremity injuries (IRR, 2.57 [95% CI, 2.49-2.64]; P < .001), upper extremity injuries (IRR, 2.24 [95% CI, 2.15-2.34]; P < .001), and concussions (IRR, 3.85 [95% CI, 3.59-4.13]; P < .001) when analyzed by kickoffs. When the 2023 NFL season was compared with the 2024 NFL season, it showed a statistically significant rise in overall injuries (IRR, 1.05 [95% CI, 1.03-1.07]; P < .001), lower extremity injuries (IRR, 1.70 [95% CI, 1.65-1.75]; P < .001), upper extremity injuries (IRR, 1.49 [95% CI, 1.43-1.55]; P < .001), and concussions (IRR, 2.25 [95% CI, 2.38-2.74]; P < .001) when analyzed by returns. When the 2023 season was compared with the 2022 season, there was a statistically significant decrease in the number of concussions when analyzed by both kickoffs (IRR, 0.20 [95% CI, 0.19-0.21]; P < .001) and returns (IRR, 0.31 [95% CI, 0.29-0.34]; P < .001).Conclusion:Our study showed that after the 2024 NFL kickoff rules were implemented, there was a significant increase in overall, lower extremity, and upper extremity injuries compared with the previous 2 seasons, as measured by the number of kickoffs and returns per year. The overall effect of the 2024 NFL kickoff rules on the incidence of concussions remains unclear when compared with the previous 2 seasons, as there was an increase in the incidence of concussions compared with 2023 and a decrease in the incidence of concussions compared with 2022. The kickoff remains an essential component of the game and still presents a challenge, as it is a play with a high injury rate.

Evidence to understand effective strategies for surveillance and early detection of SARS-CoV-2 is limited. To describe the results of a rigorous, large-scale COVID-19 testing and monitoring program. The U.S. National Football League (NFL) and the NFL Players Association (NFLPA) instituted a large-scale COVID-19 monitoring program involving daily testing using 2 reverse transcription polymerase chain reaction (RT-PCR) platforms (Roche cobas and Thermo Fisher QuantStudio), a transcription-mediated amplification platform (Hologic Panther), and an antigen point-of-care (aPOC) test (Quidel Sofia). 32 NFL clubs in 24 states during the 2020 NFL season. NFL players and staff. SARS-CoV-2 test results were described in the context of medically adjudicated status. Cycle threshold (Ct) values are reported when available. A total of 632370 tests administered across 11668 persons identified 270 (2.4%) COVID-19 cases from 1 August to 14 November 2020. Positive predictive values ranged from 73.0% to 82.0% across the RT-PCR platforms. High Ct values (33 to 37) often indicated early infection. For the first positive result, the median Ct value was 32.77 (interquartile range, 30.02 to 34.72) and 22% of Ct values were above 35. Among adjudicated COVID-19 cases tested with aPOC, 42.3% had a negative result. Positive concordance between aPOC test result and adjudicated case status increased as viral load increased. Platforms varied by laboratory, and test variability may reflect procedural differences. Routine RT-PCR testing allowed early detection of infection. Cycle threshold values provided a useful guidepost for understanding results, with high values often indicating early infection. Antigen POC testing was unable to reliably rule out COVID-19 early in infection. The NFL and the NFLPA.

Background: Lower extremity (LEX) strains, including hamstring, quadriceps, adductor, and calf strains, are among the most common injuries in sports. These injuries lead to high burden, resulting in significant missed participation time. Purpose: To describe the incidence of LEX strains in professional American football. Study Design: Descriptive epidemiology study. Methods: This study included all players who played in ≥1 National Football League (NFL) game or sustained a LEX strain during participation in the 2015-2019 seasons. LEX strain frequency was calculated by setting (game, practice, conditioning), timing in season (offseason, preseason, regular season, postseason), and roster position. Game incidence rates were calculated for season, roster position, and play type. LEX strains were identified in the standardized leaguewide electronic health record (n = 32 teams). Results: Across 5 years, 5780 LEX strains were reported among 2769 players (1-year risk, 26.7%; 95% CI, 26.0%-27.3%); 69% (n = 4015) resulted in time loss. Among all LEX strains, 54.7% were hamstring (n = 3163), 24.1% adductor (n = 1393), 12.6% calf (n = 728), 8.3% quadriceps (n = 477), and 0.3% multiple muscle groups (n = 19). Most were reported during preseason practices (n = 1076; 27%) and regular season games (n = 1060; 26%). The 2-week period of training camp practices comprised 19% of all time-loss strains. Among game injuries, preseason games had the highest rate of LEX strain (2.9/10,000 player-plays; 95% CI, 2.6-3.2). Defensive secondary players accounted for the highest proportion of time-loss LEX strains (27%; n = 1082). In games, punt plays had nearly twice the injury rate of kickoff plays (14.9/1000 plays [95% CI, 13.1-17.0] vs 7.5/1000 plays [95% CI, 6.2-8.9], respectively) and >3 times the rate of pass plays (4.3/1000 plays; 95% CI, 4.0-4.7) and run plays (2.6/1000 plays; 95% CI, 2.3-2.9). In aggregate, LEX strains led to an estimated 16,748 participation days missed each year and a median 12 days missed per injury. Conclusion: LEX strains affected 1 in 4 NFL players each year, resulting in a high burden of injury in terms of time lost from practice and competition. Safe return to the NFL season during training camp and reduction of injuries during regular season games are key focuses for future injury reduction.

ObjectiveTo assess interrelationships among neuroimaging findings with neurocognitive test performance and symptom endorsement in a cohort of retired professional (NFL) football players.DesignProspective cohort study.SettingNeurology clinic.ParticipantsForty-five retired NFL players.InterventionMRI scan assessment of cavum septum pellucidi, global mean score of Fractional Anisotropy (FA), and microhemorrhages.Outcome measuresNine neuropsychological tests and multiple symptom and depression scores. Associations among the three independent neuroimaging results with these outcome measures were assessed utilising Pearson’s, Spearman’s Rank, and Point-Biserial Correlations.ResultsThe retirees reported an average of 6.9 (±6.2) concussions and 13.0 (±7.9) sport-related “dings” in the NFL. Assessment of cavum septum pellucidum yielded a negative finding in 10 subjects (22%), while 32 (71%) had a small, and 3 (7%) had a large one. Four (9%) of the subjects had microhemorrhages present and average FA mean was 0.459 (±0.035). Number of sport-related “dings” was correlated with an increased risk of microhemorrhages (r=0.305, p=0.042). The majority (50.8%) of the correlations obtained among the three neuroimaging parameters and the neurocognitive/symptom scores were below the threshold of a “small” effect size (r&lt;0.10). The remaining (49.2%) correlations fell somewhere between “small” and “medium” effect sizes (0.1&lt; r&lt;0.3). However, all correlations were statistically non-significant.ConclusionsThe current results demonstrate minimal and statistically non-significant correlations among neuroimaging, neurocognitive, and symptom scores examined in a cohort of NFL retirees. While an often-accepted paradigm, certain neuroimaging findings may not relate consistently and directly with neurocognitive test performance and clinical symptom burden.Competing interestsNone.GS Solomon receives consulting fees from the Tennessee Titans (NFL), the Nashville Predators (NHL), and the athletic departments of several universities; all fees paid to institution. In addition he is a member of the ImPACT Scientific Advisory Board and receives reimbursement for expenses to board meetingsAK Sills is a consulting physician to the Nashville Predators (uncompensated) and also serves as an unaffiliated neurotrauma consultant for the NFLExaminations of the NFL retirees were sponsored by the National Football League (NFL) and coordinated with the NFL Players Association (NFLPA). IR Casson served as a member of the NFL MTBI Committee from 1994-2009 and as a co-chair from 2007-2009. He has done consulting for law firms and insurance companies.

The article by Professor Ethan Lock that I have been asked to introduce explains in detail the history of the long struggle between the National Football League Players' Association (NFLPA) and National Football League (NFL) owners in the courts and before the National Labor Relations Board (NLRB).The article also indicates how the labor-management problems that have separated the two sides can be resolved.These problems can be cured if both sides: clearly recognize the realities of the caselaw established in the 1970s, examine carefully their own self-interest, and give at least a casual glance to the public's interest in finding a workable relationship.However, absent such a realistic assessment the battle will likely rage into the next decade.To understand the current dispute in the NFL, Professor Lock provides a useful legal background, highlighting the history of player restraints in the NFL and the unique nature of collective bargaining in the context of the football industry. 1Professor Lock then suggests solutions which stem from both our public policy toward labor-management conflicts, as embodied in the labor laws, and the public interest inherent in those conflicts. 2However, in order to appreciate and understand the current dispute, one must grasp more than labor law principles and a vague sense of the public interest.Therefore, in the next several pages I will describe the third side of the framework-the perspective of the various interested parties in the dispute.

This research paper analyzes how the cases of NFL players Adrian Peterson, Tom Brady, and Ezekiel Elliot have affected the role of the commissioner of the National Football League (NFL) and the commissioner’s disciplinary authority in the NFL. Although the commissioner is considered a powerful figure, and historically courts have deferred to the commissioner concerning matters of league discipline, this deference is not limitless. The Peterson, Brady, and Elliot cases each helped shape how the role of the commissioner and the commissioner’s disciplinary authority in the NFL is being amplified in light of the language used in the current collective bargaining agreement (CBA) negotiated by the the NFL and the NFL Players Association (NFLPA) in 2011, legal precedent that limits a court’s ability to review an arbitrator’s decision, the law of the shop, and the CBA’s missing due process protections traditionally found in the court room. The findings and implications learned from "the Trilogy" show that players were unable to secure by lawsuit what they failed to achieve through collective bargaining. Although "the Trilogy" illustrates the commissioner’s vast authority, the next round of collective bargaining negotiations are an opportunity for the both the League and the NFLPA to cooperatively revise the player discipline process to curb a consistent stream of high-profile and public challenges of commissioner discipline, possibly encouraging the sides to move away from an adversarial relationship toward a more of a partnership.

Observed Versus Expected COVID-19 Infections Among National Football League Players During the 2020 Season.

WITH THE 30-DAY suspensions of 13 players in the National Football League (NFL) who had positive tests for anabolic steroids coming to an end, an examination of their impact is timely. (There were 24 positive steroid tests, but 11 players had already been cut by various teams before the results were announced.) Don Weiss, executive director of the NFL, hopes the message to professional football players will be that the use of anabolic steroids will not be condoned by the league. This is the third year that players have been tested for steroids, but the first time any penalty was attached to their use. Only one preseason drug test of professional football players is allowed under the contract with the NFL Players Association and that test is done at the beginning of training camp. <h3>Facing Further Testing</h3> However, there is a provision for "reasonable cause" testing. The 13 players who

WITH THE 30-DAY suspensions of 13 players in the National Football League (NFL) who had positive tests for anabolic steroids coming to an end, an examination of their impact is timely. (There were 24 positive steroid tests, but 11 players had already been cut by various teams before the results were announced.) Don Weiss, executive director of the NFL, hopes the message to professional football players will be that the use of anabolic steroids will not be condoned by the league. This is the third year that players have been tested for steroids, but the first time any penalty was attached to their use. Only one preseason drug test of professional football players is allowed under the contract with the NFL Players Association and that test is done at the beginning of training camp. Facing Further Testing However, there is a provision for reasonable cause testing. The 13 players who

The National Football League (NFL) and the NFL Players Association (NFLPA) began the 2020 football season in July, implementing extensive mitigation and surveillance measures in facilities and during travel and gameplay. Mitigation protocols* were evaluated and modified based on data from routine reverse transcription-polymerase chain reaction (RT-PCR) tests for SARS-CoV-2, the virus that causes coronavirus 2019 (COVID-19); proximity tracking devices; and detailed interviews. Midseason, transmission was observed in persons who had cumulative interactions of <15 minutes' duration, leading to a revised definition of high-risk contacts that required consideration of mask use, setting and room ventilation in addition to proximity and duration of interaction. The NFL also developed an intensive protocol that imposed stricter infection prevention precautions when a case was identified at an NFL club. The intensive protocol effectively prevented the occurrence of high-risk interactions, with no high-risk contacts identified for 71% of traced cases at clubs under the intensive protocol. The incorporation of the nature and location of the interaction, including mask use, indoor versus outdoor setting, and ventilation, in addition to proximity and duration, likely improved identification of exposed persons at higher risk for SARS-CoV-2 infection. Quarantine of these persons, along with testing and intensive protocols, can reduce spread of infection.