As we approach yet another Super Bowl, we will hear the media endlessly debate the state of the game. Is the league growing? How do we explain the decline in TV viewers? Have the political protests hurt the game? Is football too dangerous, and can we make football safer?

Based mainly on the concerns of head trauma in football, I believe we will see a steady decline in the NFL and college football over the next 10 to 20 years, especially as we see participation numbers at the youth level continue to fall.

Should kids play only flag football?

The NFL continues to promote the idea of creating a safer sport, but there is no way to completely eliminate the risk of brain damage in football. I do think there are changes we could make to at least decrease that risk. These ideas could keep the sport somewhat close to the way it’s played now.

Changes to make football safer

Let’s start with ideas to make football safer for all levels of football and not just the NFL.

Doctors and athletic trainers required to play

The NFL requires over 30 medical personnel at every game. At the youth and high school levels, there is often little coverage at all. High school teams should have an athletic trainer at every practice and game. A doctor should be present on the sideline of both teams at every game. If such coverage isn’t possible, the team can’t play.

Also read:
Football risk for young brains: An interview with Dr. Robert Stern

More non-contact practices

More and more research points to the role of repetitive subconcussive blows as the culprit in CTE, the degenerative brain condition that has affected many former players. Football players withstand a huge number of these impacts over a long career. By making practices non-contact, we can dramatically decrease the cumulative effect of these blows.

Flag football for all kids until high school

Evidence shows that the concussions and repetitive subconcussive blows might do more harm to kids whose brains are still developing. Young athletes can play flag football to learn the movements and strategies of the sport without sustaining hundreds of brain impacts from tackling and blocking each season. If you’re worried that change will prevent a kid from succeeding in the sport, understand that Tom Brady and Jerry Rice, arguably the two greatest players of all time, did not play tackle football until high school

Also read:
Parents and kids should consider flag football

Elimination of the three-point stance

Linemen absorb many hundreds of repetitive subconcussive impacts each season, which is largely why many of the former NFL players diagnosed with CTE have been offensive and defensive linemen. Removal of the three-point stance, in which a lineman crouches with his hand on the ground, allowing him to launch himself at the opposing lineman, should greatly decrease the impacts over an athlete’s career.

Making players sit out the next game after a concussion could make football safer

Elimination of kickoffs

No article I’ve written in recent years has generated more criticism than the one in which I proposed removing kickoffs from the sport. I still think it needs to happen. After all, kickoffs only make up 5.8 percent of plays in a game but cause 23.4 percent of concussions. And they lead to a huge percentage of the catastrophic injuries at the high school and college levels.

Also read:
Let’s make football safer and eliminate kickoffs

Mandatory brain trauma education for all players

Athletes at all levels need to understand the risks of playing football. Maybe ex-49er player Chris Borland, who retired early into his career out of fear of the health risks in football, could speak to them. Or Chris Nowinski, Ph. D. of the Concussion Legacy Foundation or Drs. Ann McKee or Robert Stern of Boston University’s Chronic Traumatic Encephalopathy Center could offer live or online presentations. Players would be required to watch them to be cleared to play.

For the NFL specifically, here are a few more ideas to make football safer.

Mandatory one-game absence after a concussion

Any player diagnosed with a concussion would be required to miss at least one game, regardless of where in the concussion protocol a player might be. Protocols would have to be in place to make sure teams didn’t use “concussion-like symptoms” or some other loophole to avoid a concussion diagnosis and the mandatory one-game absence.

Removal from the game for signs of a serious head injury

If a player suffers a hit that causes him to stumble, fall or struggle to stand (remember the injuries of Travis Kelce or Cam Newton) or exhibits a motor sign of a serious injury (remember the injuries of Travis Tom Savage), that player must be pulled out of the game and may not return. Ignore the argument that players go down intentionally to save the team from using a timeout.

Create a licensing board

Much like boxing, where a fighter must get a license from a medical advisory board to fight in a state, a player could be required to be examined by independent doctors. Maybe an annual brain MRI, or a CTE test when one is available, could be part of the licensure process.

Note: A modified version of this article appears as my sports medicine column in the January 23, 2018 issue of The Post and Courier.