Travis Pham
Associate Editor
Loyola University Chicago School of Law
The NFL season is back! Fans are buzzing about new uniforms, preseason rankings, and highlight-worthy plays, and there’s plenty to get excited about. Yet amid all the excitement, one issue continues to remain a pressing concern – the health and safety of the players. Football delivers thrills on the field, but the physical toll on athletes often lasts long after the final whistle. This season offers a chance to take a closer look at how far the NFL has come and how much work remains when it comes to protecting its players.
A history of concussions and the NFL’s early denial
Concussions are hardly a new discovery. A concussion occurs when a blow to the head or body causes the brain to move rapidly inside the skull, leading to temporary disruption of normal brain function. As early as 1870, physician James Crighton-Browne warned that anyone who suffered such an injury should avoid another for the rest of their life. Nearly a century later, in 1952, Harvard physician Augustus Thorndike advised that three concussions in a collision sport should be enough to recommend retirement. Despite longstanding medical awareness, the NFL did not formally address concussions until 1994, when Commissioner Paul Tagliabue created the Mild Traumatic Brain Injury Committee, a league-appointed panel tasked with studying head injuries in players. Rather than providing independent science, however, the committee became controversial for minimizing risk, with Tagliabue himself dismissing concussions as an “occupational risk” and a “pack journalism issue.” He later admitted regret for those remarks, but the damage was already done.
So why didn’t the NFL acknowledge the obvious risks in a high impact sport like football? The answer is straightforward: protecting the league’s business interests took priority over protecting its players.
Small steps forward, but not enough
In 2011, the NFL’s Head, Neck and Spine Committee introduced the NFL Game Day Concussion Diagnosis and Management Protocol. This framework created a step-by-step process for identifying, diagnosing, and treating concussions. Updated annually, the protocol requires baseline testing, immediate removal from play when a concussion is suspected, and medical clearance before an athlete can return.
On paper, this was a major improvement. Yet critics argue that the NFL’s five-step “return-to-play” process is vague about minimum recovery times and leaves room for outside pressures to influence clearance decisions, such as financial incentives, competitive stakes, and even player self-reporting, In other words, the system can still prioritize speed over safety. Additionally, the NFL introduced Guardian Caps—padded shells worn over helmets in practices and preseason – to reduce head impact forces by up to 20% when both players wear them. Since 2022, certain high-contact positions have been required to use them in training camp, but not in regular season games. While the Guardian Caps represent a visible step toward safety, critics argue their limited use makes them more symbolic than substantive, with some players questioning comfort, effectiveness, and whether they create a false sense of security.
Ensuring compliance with health and safety standards
The NFL, together with the NFL Players Association, has implemented internal league measures such as using unaffiliated medical personnel during games to independently assess injury events. Equipment regulations have been strengthened: helmets are tested annually in labs, and underperforming helmet models have been banned. The NFL has instituted rule changes to reduce high-risk plays (e.g., defenseless player protections, limitations on helmet-to-helmet contact) and more oversight during practices, especially during contact drills.
State laws (many modeled after the “Lystedt Law”) require youth athletes to be removed from play if a concussion is suspected, education of coaches and parents, and medical clearance before return to play. All 50 states now have some form of such legislation. These external and legal pressures have sparked scholarly and public debate about whether the Occupational Safety and Health Administration (OSHA) should consider NFL players as employees under a workplace safety regime, which would subject NFL teams and the league to OSHA’s general duty clause and other workplace health mandates.
Despite existing protocols, several compliance gaps persist. Return-to-play timing can be ambiguous. Studies show that players often resume play much sooner than medically optimal, with one article noting NFL players return around nine days post-concussion, even though full recovery may require significantly more time. Enforcement of protocols is also inconsistent. While sanctions such as fines or loss of draft picks exist, oversight mechanisms do not always catch violations in real time. Additionally, there is a lack of uniform standards across levels and limited transparency. Although the NFL has its own protocols, no federal regulation mandates compliance across professional sports, and state laws primarily address youth and high school athletes, leaving how medical evaluations are handled largely unclear.
A path forward
The NFL has established a framework for concussion protocols that largely reflects medical best practices, but significant compliance challenges remain in enforcement, outcome measurement, and aligning incentives so that player health is not subordinated to competitive or commercial pressures. To strengthen compliance, the league could define minimum rest and recovery periods in the return-to-play protocol based on medical research, enhance real-time oversight by using independent auditors to monitor protocol adherence during games and practices, and increase transparency by making medical clearance decisions more visible and subject to review. Additionally, clarifying the league’s legal status and obligations under OSHA or similar workplace safety laws could formalize employee safety duties and sharpen accountability. If the NFL can fully meet its regulatory, occupational, and ethical obligations, it would serve as a model not only for professional sports but also for any high-risk occupation where health is often compromised for performance.