NFL reports lower-body injuries down, concussions up in 2023 season

The Athletic

February 2, 2024

During the 2023 season, the NFL saw a dramatic increase in overall player availability. The number of concussions, however, slightly increased, which is reflective of the league’s struggles to reduce head injuries.

The NFL received its end-of-season injury data, which was compiled by health research company IQVIA, Thursday. The Athletic was on a call between reporters and officials from the NFL and IQVIA to discuss the results.

Emphasis on lower-body injuries paid dividends

Overall, players missed 700 fewer games due to injury in 2023 than in 2022. The NFL believes the primary factor in that reduction is a drop in the number of lower-body injuries. The NFL reported that half of the decrease in the number of missed games stems directly from the reduced number of lower-extremity sprains and strains, knee injuries and various non-contact leg injuries. Historically, those types of lower-body injuries result in the most games missed.

The NFL credits the change to an effort that began in 2022 to err on the side of caution in preventing, managing and returning from lower-body injuries. In talking with teams, they emphasized how lower-body injuries are handled in the first two weeks of training camp, and both the process and results carried over to the regular season.

“We’ve made it an offseason priority to talk with coaches, strength coaches and performance directors about trends and observations, particularly in how we bring players back,” NFL chief medical officer Dr. Allen Sills said. “That strategy is paying off.”

Concussions remain an issue

The total number of concussions suffered in preseason and regular-season practices and games was 219 in 2023, up from 213 in 2022. Concussion numbers are lower than they were a few years ago, but that progress has largely stagnated.

“We want to see them go down,” Sills said.

The NFL conducted about 1.6 concussion evaluations per game in 2023. A positive concussion diagnosis emerged every three to four evaluations. According to the NFL, only 1 percent of their documented concussions showed up on a delayed basis after being missed by a game-day evaluation.

Of the reported concussions, 43 percent were self-reported by players. The league maintains that’s reflective of a sound protocol.

“I think it’s fair to say there’s an increasingly conservative nature in which we examine and diagnose players,” Jeff Miller, the NFL’s executive VP overseeing player health and safety, said.

With that being said, the NFL’s concussion evaluation process remains flawed. It’s inherently subjective, which leads to concussions being missed altogether.

When it comes to further reducing concussions going forward, the NFL said it’s focused on two key issues.

The first is reducing the volume of head impacts, particularly among offensive and defensive linemen. The second is cutting down on what the league called “high-risk, high-velocity” head impacts, which typically occur when players are tackling in space. Their plan to do so revolves around education, enforcement and equipment.

More equipment, rule changes on the horizon

The NFL reported that the mandatory use of Guardian caps for linemen and running backs in preseason practices has resulted in a 50 percent decrease in concussions since 2022. While they’re also used in regular-season practices now, they still won’t be used in games, which is where the majority of concussions occur.

In working to reduce in-game concussions, the NFL is focused on position-specific helmets. Equipment company VICIS has quarterback-specific, lineman-specific and other customized helmets, and the NFL expects several other companies to join the fray this year. Looking ahead, the NFL has approved testing of position-specific helmets for receivers, safeties and cornerbacks for future seasons.

The use of those helmets will take time to catch on — if they do at all. In the meantime, the NFL is also aiming to change player behavior through rule changes.

The NFL reiterated its desire to avoid helmet-to-helmet contact. For players who display a repeated history of what is deemed to be reckless behavior, the league has begun delivering increasingly strict and serious punishments, from penalties and ejections to hefty fines and suspensions.

Still, the league wants to avoid overreacting via rule changes. For example, kickoffs have been widely discussed since the NFL moved up the fair-catch line in 2023, a tweak that reduced the return rate to 22 percent. That resulted in the number of concussions suffered on kickoffs dropping by 60 percent.

The rate of concussions suffered on kickoffs that were actually returned, however, remained about the same, which indicates kickoffs haven’t been made safer. The NFL is working to find a solution that increases the rate of kickoff returns while also lowering the rate of concussions on them.

“That is something that is an offseason priority for us and for the NFL Competition Committee,” Miller said, “to try to find a way to keep the foot in the game, make that play exciting and yet make it less risky than the previous version of it.”

That dilemma — keeping the game entertaining while also trying to make it safer — goes beyond the issue of concussions. A highly debated play that could be outlawed, for instance, is the hip-drop tackle. Commissioner Roger Goodell wants it outlawed, but there’s an opposing side that views the practice as a normal football play.

The NFL said that hip-drop tackles are 20 to 25 times more likely to cause serious injury than typical tackles. The league seems intent on getting rid of the play but hasn’t decided how to do so.

“I think the football operations group and the health and safety teams have made a lot of progress in that regard in understanding what the technique is exactly and ensuring that it can be identified and officiated and coached out of the game,” Miller said.

So, while the NFL enjoyed greater player availability in 2023, there’s still a lot of work to do when it comes to improving player health and safety in 2024. Headed into similar meetings at the NFL Scouting Combine later this month, there will be plenty to discuss.

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