NFL Chief Medical Officer and VUMC Surgeon Dr. Allen Sills Talks Sports Medicine and Concussions – The Vanderbilt Hustler

On April 11, Dr. Allen Sills, Professor of Neurological Surgery at Vanderbilt Medical Center (VUMC) and NFL Chief Medical Officer (CMO), gave a presentation on sports medicine and concussions in the NFL to MHS students. 2140, a course on health care in the United States. The discussion was moderated by Professor Gilbert Gonzales and was followed by a Q&A session moderated by second student Basim Naim.

Thresholds joined the NFL as the league’s first CMO in 2017. His role is to strengthen and advance sport safety and health by guiding research and developing data-driven injury reduction and prevention methods. In his discussion, he touched on the prevalence of concussions in the league, how the league has handled COVID-19 and the future of medicine in the NFL.

The NFL Concussion Protocol

Concussion rates are high for many sports, but soccer tops the list. listing. Sills explained that concussions are inevitable in football but can be reduced. He also addressed chronic traumatic encephalopathy (ETC), a progressive brain condition that results from repeated episodes of concussions. Sills said CTE is a serious medical problem and not a hoax as some choose to believe, but he hopes strategies can be developed to reduce and prevent it.

“CTE is a very real disease entity, and we need to learn more about it,” Sills said. “But doing good research takes time, and we still come across athletes and parents every day who…[are] concerned about long-term issues.

To develop concussion prevention strategies, Sills said he and his team observe the circumstances in which players experience concussions to develop prevention methods.

For example, to manage immediate player injuries, each NFL game has a medical staff of 30 people, including athletic trainers, primary care physicians, dentists and unaffiliated neurotrauma consultants. Sills helped develop a Game Day Concussion Checklist which provides guidelines on how to assess players for concussion. All players must be assessed as required to determine if they can return to play after their injury. This checklist helps improve the ability to detect concussions in real time, and concussion assessments can be requested by anyone on behalf of another player, including teammates, coaches, game officials, stadium ATC observers or medical personnel.

Sills explained that players can also self-report concussions to receive assessments and that self-reports have greatly increased since 2017, reflecting increased education and understanding of the issue. The NFL concussion protocol requires players to be moved to a medical tent on the sidelines or changing rooms to provide privacy and visual attention by blocking out distractions.

As concussion education and awareness increases, Sills said the cooperation of players and teams shows their commitment to helping him and his colleagues make the sport safer. He clarified that during the 2021 regular season, 1.3 concussion assessments were made per game, and for every three to four players assessed, a concussion is diagnosed.

“We want to have a very broad network,” Sills said. “We agree to accept that many [evaluations] will be negative, and our players agree with that too.

Concussion Reduction and Prevention Strategies

When concussions occur, Sills said data is collected from a variety of sources to develop concussion risk reduction strategies. He explained that every concussion report has an electronic version registration, and the NFL has an extensive electronic health database for every player. Sills said he and his team are reviewing data from videos, ATC observer reports, game statistics, GPS player tracking, player attendance, stadium surface quality and other sources when concussions occur to determine various causes of concussions and develop strategies to reduce their occurrence.

“In 2017, [we asked] what could be done to immediately reduce the number of concussions suffered by NFL players? Sills said. “To solve this problem, we need to understand what is causing it and what kind of preventive measures we can take.”

The risk of concussion cannot be completely eliminated, but by making changes to the game, Sills believes player safety and health can be improved. Sills and his colleagues established risk reduction strategies such as changes in equipment, style of play, training and supervision by mapping various aspects of gameplay.

The helmet upgrade was a fundamental change pioneered by Sills and his team that helped reduce occurrences of concussion. Data shows that the side of the helmet is the most common impact location that leads to concussions. By developing a helmet-performance ranking methodology, Sills evaluated the helmet safety of all NFL teams.

In 2017, just under half of the helmets used by NFL teams were classified like “not recommended” or “should be prohibited”. But since 2019, all NFL helmets are performance approved. Sills said switching helmets used by teams was not an easy change, but the education and safety data helped persuade teams and players.

In addition to equipment improvements, Sills said changes in playing technique and contact patterns can help reduce concussions. Sills explained that lowering his head to initiate and make contact with another player increases the risk of injury due to the head-spine-torso alignment. Based on Sills’ research, the NFL amended its rules prohibiting a player from lowering their head and priming or making contact with their helmet. Violation of this rule may result in a foul or ejection from the game. Although the change was controversial among fans, it was supported by the NFL Players Association.

The implementation of the new kick-off and blindside blocking rules also resulted in a 38% decrease in concussions, by Sills. Sills said he encourages coaches to use the “hands first” approach to teaching blocking, which involves leading with hands or shoulders rather than helmets. Sills and his team found that this technique is four times less likely to cause injury.

Sills also noted other aspects of injury prevention that are being developed. For example, the NFL is working with Amazon to develop digital copies of each player to use as a modeling tool to predict the individual effects of various injuries, games and techniques. Sills said he is also working on a turf innovation project looking at surfaces implicated in lower extremity injuries. This effort also involves using athlete feedback to reduce injury without affecting performance.

The NFL and COVID-19

Sills and the NFL Medical Committees were heavily involved in the development of the The NFL’s response to the COVID-19 pandemic, and he referenced that experience in his discussion.

“In the pre-omicron era, we never saw transmission across the line of scrimmage, from team to team,” he said. “In 2020, when no one was vaccinated, many of our teams were going to virtual meetings. When we had team outbreaks, separating them, except to be outside on the training ground, was really important in overcoming that.

The NFL strictly adhered to the CDC protocols and conducted contact tracing to prevent outbreaks among teams and within the league. In 2021, over 97% of players, coaches and associates have been vaccinated and boosted. Throughout the pandemic, Sills and his colleagues collected detailed data on COVID-19 as well as its transmission and health effects. The NFL published this research in conjunction with the CDC, and it has been used by the CDC and the White House COVID-19 task force.

Sills compared the NFL’s response to the COVID-19 pandemic to the importance of teamwork and collaboration involved in football. He said the willingness of NFL players, coaches, teams and associates to adhere to protocols and mitigate the impacts of the virus is similar to the collaboration the NFL is showing in concussion prevention. and injuries.

Sills concluded his presentation by explaining his philosophy for advancing player health and safety.

“The best treatment is prevention,” he said.

He said he believed football could still be exciting while being made safer.