Football is known as a high injury sport. The early iteration of football was very dangerous, but there have been many changes to the game over the last century. A previous post discusses how equipment like helmets and pads have made the game safer. At the same time, rule changes in football have improved player safety.

Rule changes in football are essential in the discussion of injury and concussion prevention because injury rates continue a downward trend. Over the last 15 years, there have been many changes to the game to decrease concussions and overall injuries. The game not only looks different but is also played differently.

This post will discuss the evolution of football to its current state regarding important rule changes and practice restrictions. It will include the following topics:

Early Football Was a Dangerous Sport

The First Crisis and Rule Changes in Football

National Recognition of Head Injuries in Football

Major Spark for Rule Changes in Football

Recent Rule Changes in Football by NFL

State Laws Decrease Concussions in Sports

Game Rule Changes in Football Decrease Concussion Rates

Limiting Contact Practices Decrease Concussion Rates

Early Football Was a Dangerous Sport

The first football game was over 150 years ago between two Ivy League schools.¹ Less than 10 years later, in 1876, Walter Camp, the father of American football, wrote the first rules of football in America. Football became a major event for local athletic clubs on the east coast as it grew in popularity during the first 30 years.

The early years of football looked much different than it does today. Early football rules allowed violence to interest spectators. Players could “hack, throttle, butt, trip up, tackle below the hips, or strike an opponent with closed fist three times before he was sent from the field.”² A ball carrier that was tackled could continue crawling forward for more inches until more players piled on and kicked him to stop.

Between 1900 and 1905, at least forty-five players died nationwide from injuries during games.² As football became more popular so did the recognition of these dangers.

The First Crisis and Rule Changes in Football

People began to speak out against football. University leaders expressed their disapproval and began to ban football from their campuses. Of course, there was a lot of opposition from those who loved the sport.

Acting President Teddy Roosevelt took a stand for football because he was a supporter of football’s physicality in training young men.² At the same time, President Roosevelt knew that the sport needed to change to make its physical nature more acceptable to the public, so he organized a summit at the White House in 1905.

This summit saved American football. Big rule changes made the game less violent like penalties against hitting and prohibiting dangerous mass formations. New rules promoted excitement in other ways like legalization of the forward pass. In 1910, the National Collegiate Athletic Association (NCAA) began regulating, enforcing, and updating the rules, which resulted in many fewer injuries and deaths.²

National Recognition of Head Injuries in Football

The mid to late 1900s involved many other rule changes to make football safer.¹ However, head injuries and long-term problems following football began to gain national recognition. In 1992, three-time Pro Bowl wide receiver Al Toon retired before the age of thirty due to a head injury. Then, two years later, running back Merrill Hoge also retired after getting kneed in the head while blocking. Both men were outspoken with their reasons to leave the game; they were fearful what the next big hit may do.

The 1994 season became known as “The Season of the Concussion” because many popular players, including quarterbacks, sustained concussions that year.³ In response to all the hype, NFL commissioner Paul Tagliabue assembled a committee to research the issue. The NFL’s Committee on Mild Traumatic Brain Injury (mTBI) consisted of 14 team doctors and scientists. Their purpose was to research the impact of concussions and head injuries in football and determine if football was truly harmful to players and their brains.

This quickly led to another rule change in 1995: the helmet could not be used to strike a defenseless player.

Major Spark for Rule Changes in Football

Although head injuries were forgotten, events in the early 2000s brought the topic back to the public’s eyes. Dr. Bennett Omalu examined and found disease in the brain of the famous Mike Webster who played center for the Pittsburgh Steelers.³ He published a case article in 2005 titled “Chronic Traumatic Encephalopathy in a National Football League Player.”

This was the first case of Chronic Traumatic Encephalopathy (CTE) in a football player when a similar disease was only previously described in boxers. They soon discovered more cases and along with lawsuits against the NFL, the media preemptively spread the news that football causes long-term brain problems.

With all the public attention and litigation, the NFL needed to make changes to save American football. In 2010, the league became more proactive on the issue by changing several rules.⁴

• Defenseless players were given more protection by preventing blows to the head or neck by a launching opponent on a player who has just completed a catch.
• Kickers, punters, and quarterbacks could not be contacted in head following a kick or throw.
• Defensive players were no longer allowed to rush directly over a long snapper.
• Play was whistled dead if a ball carrier’s helmet was removed.
• New and updated return to play guidelines for those suspected of having a concussion.
• Fines for players who committed “devastating hits” and “head shots.”

Recent Rule Changes in Football by NFL

Since the initial rule changes in 2010, there have been many other revisions to make the game safer, prevent concussions, and manage head injuries:⁴

• 2011- Kickoffs from 30- to 35-yardline to encourage touchbacks. Kicking team players could not get more than a 5-yard head start. The “defenseless player” rules were expanded to kickers, punters, quarterbacks, and players who receive a blindside block. Wide receivers were allowed time to complete a catch and protect themselves before no longer considered defenseless. The NFL Head, Neck and Spine Committee created a new standardized sideline concussion assessment protocol for team medical personnel that included a symptom checklist, limited neurologic examination, and balance assessment.
• 2013- Initiating forcible contact with the top or crown of the helmet by a ball carrier or tackler became illegal when clearly outside the tackle box. Blocking below the waist by offensive linemen and “bunch” formations on kickoff were eliminated.
• 2014- Clipping and unnecessary roughness penalties were expanded to prevent blockers from rolling the defender’s leg.
• 2015- Offensive backs were prohibited from chopping below the waist when a defensive player is engaged with another offensive player. The “defenseless player” expanded to defenders who were attempting to and completing the process of intercepting a pass.
• 2016- All chop blocks became illegal. Horse collar tackle penalties expanded to any grabbing at or above the nameplate and pulling the ball carrier down.
• 2017- A backfield player in motion was prohibited from crackback blocking a defender. The “defenseless player” protection expanded to any receiver running a pass route. A defender could no longer run and jump over the line of scrimmage in attempt to block a field goal or point after touchdown.
• 2018- Lowering one’s head (except bracing for contact) and initiating contact with the helmet against an opponent became a personal foul pertaining to ALL players on ALL areas on the field—the Use of Helmet Rule. This became a 15-yard penalty and could result in disqualification. Kickoffs were modified in multiple ways including preventing ‘high-bouncing’ onside kicks. Touchbacks after a kickoff were moved from the 20- to 25-yard line to encourage touchbacks and prevent collisions on kickoff.
• 2019- The kickoff rules from 2018 were made permanent as there were 35% fewer concussions on kickoff plays in 2018 versus 2017. The blindside block was eliminated by penalizing a player from initiating contact with an opponent who does not see it coming.
• 2020- The “defenseless player” protection was expanded to kick and punt returners to have the same ability to catch and prepare for contact by a defender as a receiver. Initiating contact with the helmet by linemen became points of emphasis for officials.
• 2021- Blocking below the waist became prohibited by all players if it occurred outside of the tight end box. The Use of Helmet Rule of 2018 continued to be a point of emphasis.
• 2023- Players must not use their helmet to “butt, ram, spear” or make forcible contact to opponents’ head or neck area in any way, which expands the Impermissible Use of the Helmet rule.

State Laws Decrease Concussions in Sports

In 2009, the state of Washington became the first state legislature to create a concussion-related law.⁵ It required removal and clearance of an athlete suspected of having a concussion before returning to play. The Lystedt law was named after a Zackery Lystedt who was a middle-school football player that suffered major complications from a severe traumatic brain injury after returning to a football game prematurely in 2006.⁶

By 2014, every US state had state legislature regarding concussions. Although they were all different, they shared three main principles, as stated below by the National Federation of State High School Associations (NFHS):⁶

1. All organizations operating sports programs for athletes under the age of 18, including both schools and youth sports organizations, must provide concussion education programs and materials to coaches, parents, and student-athletes. A concussion information form must be signed by each athlete and his or her parents/guardians annually.
2. An athlete suspected of having sustained a concussion during any sports activity must be immediately removed from action and cannot be returned to play on the same day.
3. An athlete suspected of having sustained a concussion cannot return to action until having been evaluated by a licensed health-care provider trained in the evaluation and management of concussions and receiving written clearance from that provider.

These laws encourage concussion reporting and prevent worse outcomes from a second impact. One study also showed that the overall incidence and recurrent concussion rates were higher prior to these state laws compared with afterwards.⁷

Game Rule Changes in Football Decrease Concussion Rates

Many college to youth football organizations have mirrored the rule changes by the NFL to improve the safety of the game. These include eliminating high risk formations like the ‘wedge’ during kickoff returns and preventing onside kicks from bouncing high in the air. There are also penalties for helmet-to-helmet contact and hitting defenseless players.

Looking at rates of diagnosed concussions in the emergency room for high school football players, the rule made a significant change.^8,9 For the five years prior to the rule change, the concussion rate increased 10.7% and helmet-to-helmet concussions increased 17.6%. However, there was a 6.2% decrease in concussion rate and 5.6% decrease in helmet-to-helmet concussions for the five years after. Additionally, there was a significant decrease in neck injuries in the emergency room from pre-rule to post-rule implementation.

Next, there have been rule changes in football regarding concussion recognition. At the professional and college levels, there are spotters to identify players who may have received a concussion or are showing concussion signs.¹⁰ This can help get players the necessary medical attention before causing further injury.

Another possible way to improve recognition and removal from play is calling injury timeouts by officials. There is evidence that officials who have more concussion-symptom knowledge will call more injury timeouts for players suspected of having a concussion.¹¹ This means that concussion education for officials may be the next rule change in football.

Limiting Contact Practices Decrease Concussion Rates

Lastly, rule changes in football regarding practice restrictions have been useful in preventing concussion and head impacts. Most of these contact restrictions occurred following state law changes.

In 2014, the Wisconsin Interscholastic Athletic Association passed new rules that limited contact during football practice only before the start of the regular season. This rule decreased the rate of sports-related concussion sustained in practice from 0.76 per 1000 athlete exposures (AEs) in 2012-2013 to 0.33 per 1000 AEs in 2014 while the concussion rates in games remained the same.¹² This is more than a 50% decreased incidence rate of concussions in high school football practices.

Another study looked specifically at head impact exposure before and after rule changes to limit contact practices for Michigan high schools.¹³ The rule did not allow more than 2 collision practice days per week after the first game. This rule decreased head impact exposure across all positions from the one high school by an average of 42%. While this may not directly translate into decreased concussions, limiting head impacts is still important.

Conclusion

Football has always been considered a dangerous game, but rule changes have diminished injury risk. The sport of football has evolved over the last 150 years with many of the rule changes in football occurring in the last 15 years.

Most have decreased high-injury-rate plays or penalized players for excessive roughness. Other rules have decreased contact and concussions in practice. State laws have also decreased second impact complications.

Most importantly, the game is continuing to get safer so that we can maintain children’s rights to play football at any age.

References

1. Chronology of Professional Football. Pro Football Hall of Fame. Accessed January 23, 2022. https://www.profootballhof.com/football-history/chronology-of-professional-football/
2. Forgrave, Reid. Love, Zac. Algonquin Books of Chapel Hill; 2020.
3. Laskas, Jeanne Marie. Concussion. Penguin Random House LLC; 2015.
4. NFL Health and Safety Related Rules Changes since 2002. NFL Enterprises LLC. Updated 2023. Accessed February 10, 2024. https://www.nfl.com/playerhealthandsafety/equipment-and-innovation/rules-changes/nfl-health-and-safety-related-rules-changes-since-2002
5. Baugh CM, Shapiro ZE. Concussions and youth football: using a public health law framework to head off a potential public health crisis. J Law Biosci. 2015;2(2):449-458.
6. Green, L. State Legislatures Continue to Update Concussion Laws. National Federation of State High School Associations. November 15, 2018. Accessed May 1, 2022. nfhs.org/articles/state-legislatures-continue-to-update-concussion-laws/
7. Arakkal AT, Barón AE, Lamb MM, Fields SK, Comstock RD. Evaluating the effectiveness of traumatic brain injury state laws among high school athletes. Inj Epidemiol. 2020;7(1):12.
8. Obana KK, Mueller JD, Saltzman BM, et al. Targeting Rule Implementation Decreases Concussions in High School Football: A National Concussion Surveillance Study. Orthop J Sports Med. 2021;9(10):23259671211031191.
9. Obana KK, Mueller JD, Zhong JR, et al. Targeting rule implementation decreases neck injuries in high school football: a national injury surveillance study [published online ahead of print, 2021 Jun 4]. Phys Sportsmed. 2021;1-5.
10. Norton AA & Wilson J. Use of the Independent Medical Spotter in Identifying Head/Neck Injuries in Division I Football Players. Pediatrics. 2021; 147.
11. Kroshus E, Parsons J, Hainline B. Calling Injury Timeouts for the Medical Evaluation of Concussion: Determinants of Collegiate Football Officials’ Behavior. J Athl Train. 2017;52(11):1041-1047.
12. Pfaller AY, Brooks MA, Hetzel S, McGuine TA. Effect of a New Rule Limiting Full Contact Practice on the Incidence of Sport-Related Concussion in High School Football Players. Am J Sports Med. 2019;47(10):2294-2299.
13. Broglio SP, Williams RM, O’Connor KL, Goldstick J. Football Players’ Head-Impact Exposure After Limiting of Full-Contact Practices. J Athl Train. 2016;51(7):511-518.