• David J Lessley, Richard W Kent, James R Funk, Christopher P Sherwood, Joseph M Cormier, Jeff R Crandall, Kristy B Arbogast, and Barry S Myers.
• Biomechanics Consulting and Research (BioCore), LLC, Charlottesville, Virginia, USA.
• Am J Sports Med. 2018 Dec 1; 46 (14): 3502-3510.

BackgroundConcussions in American football remain a high priority of sports injury prevention programs. Detailed video review provides important information on causation, the outcomes of rule changes, and guidance on future injury prevention strategies.PurposeDocumentation of concussions sustained in National Football League games played during the 2015-2016 and 2016-2017 seasons, including consideration of video views unavailable to the public.Study DesignDescriptive epidemiology study.MethodsAll reported concussions were reviewed with all available video footage. Standardized terminology and associated definitions were developed to describe and categorize the details of each concussion.ResultsCornerbacks sustained the most concussions, followed by wide receivers, then linebackers and offensive linemen. Half (50%) of concussions occurred during a passing play, 28% during a rushing play, and 21% on a punt or kickoff. Tackling was found to be the most common activity of concussed players, with the side of the helmet the most common helmet impact location. The distribution of helmet impact source-the object that contacted the concussed player's helmet-differed from studies of earlier seasons, with a higher proportion of helmet-to-body impacts (particularly shoulder) and helmet-to-ground impacts and with a lower proportion of helmet-to-helmet impacts. Helmet-to-ground concussive impacts were notable for the high prevalence of impacts to the back of the helmet and their frequency during passing plays.ConclusionConcussion causation scenarios in the National Football League have changed over time.Clinical RelevanceThe results of this study suggest the need for expanded evaluation of concussion countermeasures beyond solely helmet-to-helmet test systems, including consideration of impacts with the ground and with the body of the opposing player. It also suggests the possibility of position-specific countermeasures as part of an ongoing effort to improve safety.

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