National Football League Research Articles

Circadian variation in coaches’ decision-making in the National Football League’s evening games

ABSTRACT The aim of this study was to explore whether National Football League (NFL) coaches show variation in their decision-making on fourth down when traveling through time zones. Data from visiting teams in games from 20 seasons (2000–2020) of the NFL were retrieved from online sources (n = 5360 games). Decision-making was measured with the percentage of offensive plays on fourth down. A factorial ANCOVA was done to verify whether travel direction had an impact on fourth downs in evening games, while controlling for the seasons. A moderation analysis was computed to verify whether the time of game moderates the relationship between longitudinal distance traveled and decisions on fourth downs. Results showed that in evening games, coaches in teams traveling westward called more offensive plays on fourth down, compared to when they traveled in any other direction. Results from the moderation analysis showed that only in evening games, further westward longitudinal degrees traveled predict more fourth downs. For the first time, this study offers insight that circadian misalignment may not only affect player performance but also influence coaching decisions in professional sports. These results beg the question whether other aspects of coaching or staff decisions show circadian variations in professional sports.

Correlation of Player and Imaging Characteristics With Severity and Missed Time in National Football League Professional Athletes With Hamstring Strain Injury: A Retrospective Review

Background: Hamstring strain injuries (HSIs) are prevalent in US National Football League (NFL) players, but there is a paucity of information regarding imaging characteristics, injury severity, and player factors associated with time missed and risk of recurrent injury. Purpose: To describe player, football activity, clinical, and imaging characteristics of NFL players with HSIs, as well as determine player characteristics, clinical examination results, and magnetic resonance imaging (MRI) findings associated with injury occurrence, severity, and missed time. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective cohort of NFL players with acute HSI (n = 180) during the 2018-2019 season was identified. Injury data were collected prospectively through a league-wide electronic health record system. Three musculoskeletal radiologists graded MRI muscle injury parameters using the British Athletics Muscle Injury Classification (BAMIC) system. Player, football, clinical, and imaging characteristics were correlated with HSI incidence and severity and with missed time from sport. Results: Of the 1098 HSIs identified during the 2018-2019 season, 416 (37.9%) were randomly sampled, and 180 (43.3%) had diagnostic imaging available. Game activity, preseason period, and wide receiver and defensive secondary positions disproportionately contributed to HSI. The biceps femoris was the most commonly injured muscle (n = 132, 73.3%), followed by the semimembranosus (n = 24, 13.3%) and semitendinosus (n = 17, 9.4%) muscles. The most common injury site was the distal third of the biceps femoris and semitendinosus muscles (n = 60, 45.5% and n = 10, 58.8%, respectively) and central part of the semimembranosus muscle (n = 17, 70.8%). Nearly half of the injuries (n = 83, 46.1%) were BAMIC grade 2; 25.6% (n = 46), grade 3; and 17.8% (n = 32), grade 4. MRI showed sciatic nerve abnormality in 30.6% (n = 55) of all HSIs and 81.3% (n = 26) of complete tendon injuries. BAMIC grade correlated with both median days and games missed. Combined biceps femoris and semitendinosus injuries resulted in the highest median days missed (27 days). Conclusion: Among NFL players with acute HSIs, the most common injury was a moderate-severity injury of the distal biceps femoris. BAMIC grade was associated with missed time.

Cannabinoid Therapy in Athletics: A Review of Current Cannabis Research to Evaluate Potential Real-World Cannabinoid Applications in Sport.

The increasing legalization of Cannabis sativa plant products has sparked growing interest in their therapeutic applications. Prohibition laws established in 1937 hindered formal research on cannabis, a plant with cultural and medicinal roots dating back to 2700 BC in Chinese history. Despite regulatory hurdles, published research on cannabis has emerged; yet elite athletes remain an underrepresented population in these studies. Athletes, known for exploring diverse substances to optimize performance, are drawn to the potential benefits of cannabinoid therapy, with anecdotal reports suggesting positive effects on issues ranging from anxiety to brain injuries. This review aims to evaluate empirical published cannabis research with a specific focus on its potential applications in athletics. The changing legal landscape, especially the removal of cannabis from drug testing programs in leagues such as the National Basketball Association (NBA), and endorsements by Major League Baseball (MLB) for cannabinoid products and the National Football League (NFL) for cannabis research, reflects a shift in the acceptability of such substances in sports. However, stigma, confusion, and a lack of education persist, hindering a cohesive understanding among sports organizations, including business professionals, policymakers, coaches, and medical/training staff, in addition to athletes themselves. Adding to the confusion is the lack of consistency with cannabinoid regulations from sport to sport, within or out of competition, and with cannabis bioactive compounds. The need for this review is underscored by the evolving attitudes toward cannabinoids in professional sports and the potential therapeutic benefits or harms they may offer. By synthesizing current cannabis research, this review aims to provide a comprehensive understanding of the applications and implications of cannabinoid use in the realm of athletics.

Lower Extremity Injury Rates on Artificial Turf Versus Natural Grass Surfaces in the National Football League During the 2021 and 2022 Seasons.

It has been argued that the use of artificial turf football fields in the National Football League (NFL) increases player injury risk compared with natural grass surfaces. The purpose of this study was to quantify the rate of lower extremity injuries occurring in NFL players on artificial turf compared with natural grass surfaces and characterize the time missed due to injury and proportion of injuries requiring surgery. It was hypothesized that lower extremity injuries requiring surgical intervention would occur at a higher rate on artificial turf than on natural grass. Descriptive epidemiology study. Lower extremity injury data for the 2021 and 2022 NFL seasons were obtained using publicly available records. Data collected included injury type, player position, player age, playing surface, weeks missed due to injury, and whether the patient underwent season-ending or minor surgery. Multivariable logistic regression was performed to determine the risk of season-ending surgery according to playing surface. When combining injuries for the 2021 and 2022 seasons (N = 718 injuries), the incidence rate of lower extremity injury was 1.22 injuries/game for natural grass and 1.42 injuries/game for artificial turf. The odds of a season-ending surgery were found to be significantly higher on artificial turf compared with natural grass (odds ratio = 1.60; 95% CI, 1.28-1.99; P < .05), while additional variables, including weather, age, position, week of injury occurrence, and history of prior injury, did not influence the odds of season-ending surgery. The 2021 and 2022 NFL seasons of our analysis demonstrated a higher incidence rate of injuries on artificial turf surfaces compared with natural grass surfaces. In addition, the odds of injury requiring season-ending surgery were found to be significantly higher on artificial turf compared with natural grass.

Predicting Sprint Performance From the Vertical and Horizontal Jumps in National Football League Combine Athletes.

Agar-Newman, DJ, MacRae, F, Tsai, M-C, and Klimstra, M. Predicting sprint performance from the vertical and horizontal jumps in National Football League Combine athletes. J Strength Cond Res 38(8): 1433-1439, 2024-Identifying fast athletes is an important part of the National Football League (NFL) Combine. However, not all athletes partake in the 36.58-m sprint, and relying on this single test may miss potentially fast athletes. Therefore, the purpose of this study was to determine whether sprinting times can be predicted using simple anthropometric and jumping measures. Data from the NFL Combine between the years 1999-2020 inclusive were used (n = 4,149). Subjects had a mean (±SD) height = 1.87 ± 0.07 m and body mass = 111.96 ± 20.78 kg. The cross-validation technique was used, partitioning the data into a training set (n = 2,071) to develop regression models to predict time over the 9.14-, 9.14- to 18.29-, 18.29- to 36.58-m, and 36.58-m segments using vertical jump, broad jump, height, and mass as the independent variables. The models were then evaluated against a test set (n = 2,070) for agreement. Statistically significant (p < 0.01) models were determined for 9.14-m time (adjusted R2 = 0.76, SEE = 0.05 seconds), 9.14- to 18.29-m time (adjusted R2 = 0.74, SEE = 0.04 seconds), 18.29- to 36.59-m time (adjusted R2 = 0.79, SEE = 0.07 seconds), and 36.58-m time (adjusted R2 = 0.84, SEE = 0.12 seconds). When evaluated against the test set, the models showed biases of -0.05, -0.04, -0.02, and -0.02 seconds and root-mean-square error of 0.07, 0.05, 0.07, and 0.12 seconds for the 9.14-, 9.14- to 18.29-, 18.29- to 36.58-m, and 36.58-m segments, respectively. However, 5-6% of the predictions lay outside of the limits of agreement. This study provides 4 formulae that can be used to predict sprint performance when the 36.58-m sprint test is not performed, and practitioners can use these equations to determine training areas of opportunity when working with athletes preparing for the NFL Combine.

Does Draft Currency Promote Competitive Balance? An Empirical Investigation of the National Football League 2002–2021

In the National Football League (NFL) annual draft, teams take turns selecting entering players. The draft is a market mechanism designed to promote competitive balance as the NFL assigns draft positions to teams in reverse order relative to last season's performance. Teams frequently trade draft picks for other picks and/or players. We use several market valuations of draft picks to define original draft currency as the total value of draft picks available before any trades and final draft currency as the total value of picks used after all trades. For the 2002–2021 period, we find that original draft currency does not affect the probability of reaching the playoffs, but final draft currency does. Usage of outdated market valuations of draft picks by most teams can help explain how the best team has used draft-pick trades to remain among the strongest teams over two decades thereby perpetuating competitive imbalance.

An Antitrust Analysis of the NCAA Transfer Policy

The National Collegiate Athletic Association (“NCAA”) is no stranger to antitrust law. As a trade association composed of nearly all U.S. colleges offering competitive sports, its rules are regularly challenged under antitrust law. In the past 40 years, the NCAA has faced challenges to rules limiting televised game broadcasts, curtailing assistant coaches’ pay, and restraining players’ compensation, among other issues. Restraints on college athlete transfers also could subject the Association to reasonable legal scrutiny. Restrictions on the ability to transfer can harm athletes by preventing their immediate eligibility even though transferring could allow them to be closer to family, enroll in more academically rigorous schools, or escape abusive coaches. Transfer restraints have an especially restrictive effect on players hoping to one day play in the National Football League (“NFL”). For these individuals, the college football system is the primary opportunity to showcase talent before declaring for the League’s draft. The NCAA’s transfer rules keep many of these elite players on their teams’ benches. This hurts their ability to prepare for careers in the NFL. And it denies football fans the opportunity to watch them perform in college. The NCAA’s rules that prevent football players from freely transferring between schools have changed over time. Why? Because of the changing preferences of members of the NCAA Division I Council (“NCAA Council”), a group of college athletic directors and administrators. In April 2021, the NCAA Council changed its rules to facilitate the movement of football players between schools, allowing athletes who had not previously switched schools to pursue transfer opportunities by entering a portal within a 60-day window. On October 4, 2023, the NCAA Council reduced the transfer window from 60 to 45 days. In this Essay, we explore the antitrust consequences of this latest action by the NCAA Council, as well as the broader competitive effects of limits on college football player movement. We conclude that: (1) the NCAA’s transfer limits impose substantial anticompetitive effects; (2) the NCAA could offer (but would need to prove) a justification based on reduced fan interest from a lack of team stability; (3) less restrictive alternatives (including the 60-day transfer window) are available; and (4) the restraint’s anticompetitive effects are likely to outweigh its procompetitive effects.

NFL’s dangerous strategies of marketing football to youth: shades of big tobacco

ABSTRACT Comparisons have been made between the tobacco industry’s historic tactics in defending their products with the responses of some key actors in the sports world to head injuries. Both, it is said, have deployed deceptive marketing and advertising techniques to entice youth to engage with a subjective pleasure-producing product that has undeniable short- and long-term health detriments. Unlike what is called euphemistically, ‘Big Tobacco’, however, the National Football League (NFL) has evaded legal restrictions on the promotion of an inherently dangerous product that targets youth. By contrast, in 1997, the Federal Trade Commission charged tobacco company R.J. Reynolds with violating federal law by using a cartoon character, Joe Camel, to allure children under age 18. The NFL has partnered with Nickelodeon to produce programs such as NFL Rush Zone and NFL Slimetime that target youth by using cartoon mascots, bright colors, 3D iconography, and other child-friendly symbols. In addition to fostering positive associations between tackle football and cartoons, these broadcasts have explicitly minimized the risks of tackling. For example, one NFL Playoffs on Nickelodeon announcer equated a forceful head collision with a scrape of the knee that a child might experience during school recess. The NFL’s marketing strategies deflect public attention away from the risks of repetitive head collisions, concussions, traumatic brain injury (TBI), and chronic traumatic encephalopathy (CTE), portraying football as an appealing activity. The ongoing connections between the NFL and youth-oriented television programming raise crucial questions about how risk is communicated in a sport with inherent dangers of long-term cognitive damage. As long as tackle football is portrayed alongside beloved cartoon characters such as Spongebob Squarepants, impressionable children are likely to form undilutedly positive perceptions of the NFL and ignore the substantial risks of repeated, full-body collisions when enchanted by brightly-colored slime, animated bubbles, and goofy dance moves.

A comprehensive survey of the home advantage in American football

Abstract The existence and justification to the home advantage – the benefit a sports team receives when playing at home – has been studied across sport. The majority of research on this topic is limited to individual leagues in short time frames, which hinders extrapolation and a deeper understanding of possible causes. Using nearly two decades of data from the National Football League (NFL), the National Collegiate Athletic Association (NCAA), and high schools from across the United States, we provide a uniform approach to understanding the home advantage in American football. Our findings suggest home advantage is declining in the NFL and the highest levels of collegiate football, but not in amateur football. This increases the possibility that characteristics of the NCAA and NFL, such as travel improvements and instant replay, have helped level the playing field.

Poster 373: Lower Extremity Injury Rates on Turf Versus Natural Grass Surfaces - An Analysis of Professional Football Athletes in the 2021 and 2022 Seasons

Objectives: As the emphasis on player safety in the national football league (NFL) has increased in recent years, numerous risk factors for injury have been closely scrutinized for their roles in placing players at increased risk. One such factor, the use of artificial turf football fields, has become a controversial topic, with many current and former players stating that turf fields place players at higher risk for injury while alternative sources have suggested there is no significant injury rate between artificial and natural grass surfaces. The purpose of this study was to quantify the rate of lower extremity injuries occurring in NFL players on artificial turf compared to natural grass surfaces and to characterize the degree of time missed with injury and the proportion of injuries requiring surgery. We hypothesized that major lower extremity injuries requiring surgical intervention occurred on artificial turf surfaces at a higher rate than on natural grass. Methods: Lower extremity Injury data for the 2021 and 2022 NFL seasons were obtained using publicly available records from the internet. All reported lower extremity injuries during the regular and playoff seasons were analyzed. Upper extremity, head, and back injuries were excluded. Preseason data was also excluded. Data collected included player position and age, playing surface of the field on which, the injury occurred, injury type, weeks missed with injury, and whether the patient underwent season-ending or minor surgery. Statistical analysis was performed using R Software (Rlabs). Descriptive statistics were used to summarize data, including percentages and counts for categorical and ordinal data and means with interquartile ranges for continuous data. Incidences of injury on both grass and turf fields were calculated for the 2021 and 2022 seasons by taking a ratio of the number of injuries that occurred and the number of games played on respective fields. Additionally, injuries were stratified by subsequent number of games missed: 0 games missed, 1-2 games missed, &gt;6 games missed. Multivariable logistic regression was performed to determine the influence of field type on the risk of major surgery. A p-value less than 0.05 was statistically significant. Results: In total there were 327 (44.12%) lower extremity injuries in 2021 and 391 (54.45%) lower extremity injuries in 2022, resulting in a total of 718 lower extremity injuries. A demographic summary of these injuries by position, age, field, and history of previous injury is displaced in Table 1. Combining the 2021/2022 seasons, the incidence rate of lower extremity injury on natural grass surfaces was 1.22 injuries/game while for turf surfaces, the incidence rate was 1.42 injuries/game (Table 2). Injury severity was stratified by weeks missed. Odds of a season-ending surgery were found to be significantly higher on turf surfaces compared to natural grass surfaces (OR 1.60, 95% CI 1.28-1.99, p&lt;0.05), while additional variables, including weather, age, position, and week of injury occurrence and history of prior injury were not found to influence the odds of season-ending surgery. In total, there were 50 players injured on the grass who required lower extremity surgery and 83 players injured on turf who required lower extremity surgeries. The most common surgeries after a lower extremity on grass were ACL repair (17), Achilles repair (9), and ankle or syndesmosis ORIF (7). The most common surgeries after a lower extremity on turf were ACL repair (30), Achilles repair (12), patella ORIF, or patellar tendon repair (8) (Table 3). Conclusions: The debate about playing on artificial turf versus natural grass has persisted for several years; however, there is a discrepancy in data reported on these overall injury rates. Our study showed that NFL athletes were more likely to get injured on artificial surfaces and that turf dramatically increased the likelihood of suffering a serious injury requiring surgery. These findings support earlier research, highlighting the necessity of putting player safety first and reducing dangers on pitches with artificial turf. For players, coaches, and teams to make wise decisions about playing surfaces, the study offers useful information regarding playing safety. Overall, it indicates that there is a higher risk of lower extremity injuries on artificial grass in the NFL, confirming the continuing discussion about field safety.

Poster 388: Calf Strains in the NFL: Demographics, RTP, Performance Analysis, and Injury Reoccurrence

Objectives: While calf strains are a common injury seen in the National Football League (NFL), there is currently no data that examines which players are suffering these injuries, how quickly they return, how well they play upon return, and how likely they are to suffer the same injury again. This study aims to dive deeper into the history of calf strains in the NFL throughout the past 10 seasons to answer these questions. Methods: This study included all NFL players who suffered a calf strain between 2013 and 2022. The data was collected using publicly available reports. Among the information gathered includes player age, player position, number of games missed, preseason participation, and rate of return. Performance pre- and postinjury was also examined for players who met inclusion criteria using data from Pro Football Focus. A paired t test analysis of the change in player performance was used for analysis. Results: In this study, 349 calf strains were identified between 2012 and 2022, involving 294 individual players. The average age of injured player was 27 years old. Wide receivers had the highest incidence of calf strain injury amongst all positions (48) and led all positions in players who did not return the rest of the season after injury (9). Of all injuries, 52.7% occurred in offensive players. The average number of games missed after injury was 1.97. 26.7% of the players with a calf strain played in zero preseason games before the season in which the injury occurred. A total of 83.7% of players with the injury returned to play during the same year. Offensive guards led all position players in those who did not return to play within the same season after injury (31.8%). Among all players who returned in the same season and met inclusion criteria, there were no significant changes in player performance from pre to postinjury. A total of 20.7% of players suffered another calf strain or Achilles tendon injury at some point throughout the rest of their careers after initial injury with wide receivers being the position group with the highest prevalence (11). Conclusions: NFL players returned in the same season 83.7% of the time and suffered no decline in performance following a strained calf. Over 20% of players suffered the same injury or a related injury to the Achilles tendon after first injury in this time period. Whether the reinjuries occurred in the contralateral or ipsilateral leg was not readily available data. Therefore, a more in- depth examination is required to see if a relationship exists between these variables.

A Swann's Song

Abstract This article uses the experiences of wide receiver Lynn Swann, then a rising star with the Pittsburgh Steelers, to historicize the issue of concussions in American football. It situates Swann's threat to retire in 1976 due to repeated head injuries within the period's broader player safety discourse. Cultural and media narratives from the 1970s contrast the sport's rapidly accelerating popularity with emerging concerns about head injuries. It examines the response of the National Football League (NFL) to such concerns, which often resembled a campaign to scapegoat on-field violence rather than a genuine effort to address player health. This approach protected American football's momentum by averting hard conversations about head injuries, in the process missing an early opportunity to confront a health crisis impacting football players at all levels. The narrative of Swann's injuries and the NFL's actions and inactions provides insight into the complexities of balancing sport enthusiasm with athlete safety, a challenge with contemporary relevance.

“When Fathers Beam and Mothers Wince”

Abstract Since the late nineteenth century, the figure of the “worried mother” has featured prominently in popular debates about American football's risks and benefits. This article analyzes portrayals of mothers’ concerns about concussions and other youth football injuries in newspapers, journals, and sports magazines. Mothers occasionally penned opinion columns or were quoted in news stories, but most commonly, the “worried mother” was depicted by male sportswriters, physicians, and coaches writing about football safety. The “worried mother” posed an existential threat to youth football should she prohibit her son from participating or insist on a wholesale transformation of the rules; she thus needed to be reassured by coaches and league administrators. From nineteenth-century appeals to the “gentler sex” to the early twenty-first-century “moms’ clinics” sponsored by the National Football League, narratives surrounding “worried mothers” profoundly shaped popular perceptions of youth football's risks.

An examination of competitive rule evolution in the National Football League

ABSTRACT Purpose/rationale Competitive rules, which have implications for player safety, fairness, and entertainment, change over time, yet institutional accounts offer only a high-level view of rule change. This study centers, and looks within, competitive rules to examine how they evolve in professional sport. Design/methodology/approach Using an inductive approach, we conducted a qualitative document analysis of NFL rule books published between 1980 and 2020. We developed and examined longitudinal trajectories of player conduct rules. Findings The analysis reveals rule components (i.e. actions, actors, times, spaces, sanctions) and patterns of change. Rules generally expanded in scope and length. We draw on communications from NFL leaders to connect the findings to institutional factors. Practical implications The findings offer a framework for rule managers as they iterate rules to make sport safer, fairer, and more entertaining. Research contribution This study sheds light on how competitive rules evolve at the level of component parts, providing a foundation for future institutional scholarship on the causes and consequences of rule change. Originality/value This research offers a microfoundations and longitudinal understanding of rule change in sport, with insights for academics and rule managers.

His Work Here Is Done: How Sports Journalists and Commentators Framed Colin Kaepernick’s Possible Return to the National Football League

A frame analysis was conducted of recent coverage by sports journalists of the on-again off-again possibility that Colin Kaepernick might sign a contract to play with a team in the National Football League (NFL). Kaepernick was blacklisted by league and team officials angry at, and hoping to avert public backlash from, Kaepernick’s 2016 decision to kneel during the national anthem to protest systemic police brutality and mass incarceration. The analysis enabled the creation of champions, distractions, exile, futility, impact, and spectacle frames. The analysis affirms that journalists may be priming readers to conclude that the NFL has learned its lesson, that some officials should be congratulated for generating the bravery to welcome Kaepernick back to the league and commended for their newfound insights about racism. The episodic frames emerging from coverage of the tryouts and a possible signing affirm that the “new appreciation” of Kaepernick has become a nonthreatening reverence for his place in history. Kaepernick’s exile now reads like a one-off, an outlier, rather than a glaring example of the systemic racism that still infects the league. Frames affirm that the NFL—with help from the nation’s sports writers and commentators—has taken control of the narrative with which fans process an athlete’s activism. They have legitimized the narrow space provided by the league for player protest.

Life After the Gridiron: Examining Retired National Football League Athletes’ Self-Presentation Strategies and Follower Engagement on Instagram Personal and Business Pages

As athletes enter a new chapter in their lives retiring from their sport, the challenge of upholding and enhancing personal brands arises. There has been extensive research on athlete brand building via social media; however, there have been few studies analyzing how athletes build their own brands and brand extensions postcareer, particularly former National Football League (NFL) players. Sixteen retired NFL athletes were examined using Goffman’s theory of self-presentation to determine strategies used for building personal brand extensions and obtaining follower engagement via Instagram. Through a content analysis, a total of 2,933 Instagram posts were analyzed, and the findings from this study revealed that former NFL players with fewer followers received higher engagement rates, and retired NFL players made more backstage type of posts on personal pages compared with front-stage posts. Implications, recommendations, and future research suggestions also are discussed within the paper.

Markov-switching decision trees

Decision trees constitute a simple yet powerful and interpretable machine learning tool. While tree-based methods are designed only for cross-sectional data, we propose an approach that combines decision trees with time series modeling and thereby bridges the gap between machine learning and statistics. In particular, we combine decision trees with hidden Markov models where, for any time point, an underlying (hidden) Markov chain selects the tree that generates the corresponding observation. We propose an estimation approach that is based on the expectation-maximisation algorithm and assess its feasibility in simulation experiments. In our real-data application, we use eight seasons of National Football League (NFL) data to predict play calls conditional on covariates, such as the current quarter and the score, where the model’s states can be linked to the teams’ strategies. R code that implements the proposed method is available on GitHub.

Distal Tibiofibular Syndesmosis Injuries in the National Football League (NFL): A Spectrum of Pathology That Correlates With Time to Return to Full Participation.

Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially influencing return to full participation. In National Football League (NFL) players, isolated high ankle sprains are rare and syndesmosis injuries with concomitant pathology will result in increased time to return to full participation. Cross-sectional study. Level 3. Distal tibiofibular syndesmosis injuries sustained by NFL players between 2017 and 2019 were identified through NFL Injury Surveillance Database queries and verified with video analysis. Each injury underwent a comprehensive magnetic resonance imaging (MRI) review. Regression modeling was utilized to explore the influence of numerous imaging findings on time to return to full participation. There were 83 external rotation ankle injuries involving the syndesmosis. Isolated distal tibiofibular syndesmosis injuries were rare (n = 11; 13%) and more often associated with other ligamentous injury (deltoid ligament and lateral ligamentous complex) and/or fractures. Regression modeling resulted in clustering of 3 injury pattern groups for time to return to full participation across numerous imaging findings: syndesmosis injury-fracture combinations (250 days [interquartile range [IQR,] 142-266 days]), syndesmosis injury with complete deep deltoid tear or acute diastasis (175 days [IQR, 20-248 days]), and all other syndesmosis injuries (27 days [IQR, 18-46 days]). In NFL athletes with external rotation ankle injuries, isolated distal tibiofibular syndesmosis injuries were rare and more often associated with concomitant pathology. Time to return to full participation was affected by an associated fracture and complete deep deltoid ligament tear or diastasis but no other relevant MRI variables such as lateral ligament complex involvement or the presence of osteochondral lesions or bone contusions.

National Football League Quarterbacks With Ulnar Collateral Ligament Injuries Have High Return-to-Play Rates, but Older Players Have Inferior Postinjury Performance

To characterize the epidemiology, mechanism (contact vs noncontact), management, and return-to-play (RTP) times for quarterbacks in the National Football League (NFL) who experienced ulnar collateral ligament (UCL) injuries. Using the Pro Sports Transactions Archive, NFL quarterbacks who sustained UCL injuries between 1991 and 2023 were identified. Age at time of injury, mechanism of injury (contact vs noncontact), management strategy, and RTP time were recorded. In addition, player performance metrics including games played, quarterback rating, completion percentage, touchdowns, and interceptions were examined for the season before injury through the second season after injury. Player performance analysis was assessed using principal component analysis, which is a dimensionality reduction statistical method that compresses the several performance metrics into a single value, the first principal component. A total of 21 injuries in 20 players were identified. The mean age of quarterbacks at time of injury was 28.7 years (± 4.6 years standard deviation). Ten injuries occurred during contact with another player, and 11 injuries were noncontact. Most (n= 13) of UCL injuries were managed nonoperatively. Sixteen players achieved RTP, 4 of whom underwent repair or reconstruction (UCLR). Overall, the mean RTP time was 165.6 days (± 178.8 days standard deviation), but players who underwent UCLR had a longer average RTP time (359.0 days vs 98.25 days, P= .014). Injuries sustained after 2006 were associated with improved postinjury performance (P= .041), but older age at time of injury was associated with diminished postinjury performance (P= .048). NFL quarterbacks sustain more noncontact UCL injuries and are undergoing UCLR at greater rates than previously reported. Although RTP rates are high and players demonstrate improved postinjury performance for injuries sustained after 2006, older age at the time of injury is associated with worse postinjury performance. Level IV, therapeutic case series.

Dynamic Visual Acuity, Vestibulo-Ocular Reflex, and Visual Field in National Football League (NFL) Officiating: Physiology and Visualization Engineering for 3D Virtual On-Field Training.

The ability to make on-field, split-second decisions is critical for National Football League (NFL) game officials. Multiple principles in visual function are critical for accuracy and precision of these play calls, including foveation time and unobstructed line of sight, static visual acuity, dynamic visual acuity, vestibulo-ocular reflex, and sufficient visual field. Prior research has shown that a standardized curriculum in these neuro-ophthalmic principles have demonstrated validity and self-rated improvements in understanding, confidence, and likelihood of future utilization by NFL game officials to maximize visual performance during officiating. Virtual reality technology may also be able to help optimize understandings of specific neuro-ophthalmic principles and simulate real-life gameplay. Personal communication between authors and NFL officials and leadership have indicated that there is high interest in 3D virtual on-field training for NFL officiating. In this manuscript, we review the current and past research in this space regarding a neuro-ophthalmic curriculum for NFL officials. We then provide an overview our current visualization engineering process in taking real-life NFL gameplay 2D data and creating 3D environments for virtual reality gameplay training for football officials to practice plays that highlight neuro-ophthalmic principles. We then review in-depth the physiology behind these principles and discuss strategies to implement these principles into virtual reality for football officiating.