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Brian Burnsed | | July 8, 2014

Guidelines to limit contact in football

For the past six months, the NCAA and College Athletic Trainers’ Society have been working with prominent medical organizations, college football coaches, administrators and conference commissioners to develop new guidelines to improve safety for student-athletes.

On Monday, those groups released three inter-association guidelines that address independent medical care for student-athletes, diagnosis and management of sport-related concussion, and year-round football practice contact.

The guidelines were created to generate a cultural shift within college athletics, encouraging all participants – athletic trainers, coaches and team physicians, among others – to embrace the parameters because they played a part in crafting them. The many groups involved in creating the documents hope that these guidelines generate immediate, tangible changes. The football practice contact guidelines, for instance, call for no more than two live contact practices per week throughout the regular season, which mirrors a policy first implemented by the Ivy League in 2011 and then by the Pac-12 last season.

Year-round football practice contact:
• Preseason: For days when schools schedule a two-a-day practice, live contact practices are only allowed in one practice. A maximum four live contact practices may occur in a given week, and a maximum of 12 total may occur in the preseason. Only three practices (scrimmages) would allow for live contact in greater than 50 percent of the practice schedule.
• Inseason, postseason and bowl season: There may be no more than two live contact practices per week.
• Spring practice: Of the 15 allowable sessions that may occur during the spring practice season, eight practices may involve live contact; three of these live contact practices may include greater than 50 percent live contact (scrimmages). Live contact practices are limited to two in a given week and may not occur on consecutive days.
Independent medical care for college student-athletes:
Institutional medical line of authority should be established independently of a coach, and in the sole interest of student-athlete health and welfare. Institutions should, at a minimum, designate a licensed physician (M.D. or D.O.) to serve as medical director, and that medical director should oversee the medical tasks of all primary athletics health care providers. The medical director and primary athletics health care providers should be empowered with unchallengeable autonomous authority to determine medical management and return-to-play decisions of student-athletes.
Diagnosis and management of sport-related concussion: Institutions should make their concussion management plan publically available, either through printed material, their website, or both. A student-athlete diagnosed with sport-related concussion should not be allowed to return to play in the current game or practice and should be withheld from athletic activity for the remainder of the day. The return-to-play decision is based on a protocol of a gradual increase in physical activity that includes both an incremental increase in physical demands and contact risk supervised by a physician or physician-designee. The return to academics should be managed in a gradual program that fits the needs of the individual, within the context of a multi-disciplinary team that includes physicians, athletic trainers, coaches, psychologists / counselors, neuropsychologists, administrators as well as academic (e.g. professors, deans, academic advisors) and office of disability services representatives.

“When you build inter-association consensus, I think it speaks much more powerfully because it’s not simply the NCAA making a rule,” said NCAA Chief Medical Officer Brian Hainline. “It’s consensus from numerous well-respected medical organizations, from football coaches, from football associations, from all of us. In terms of changing the culture around health and safety, that’s the best way to do it.”

“The opportunity to gather, at one table, the stakeholders from all disciplines in collegiate athletics, solely in the interest of student-athlete safety, is unprecedented,” added Scott Anderson, president of the College Athletic Trainers’ Society and head athletic trainer at Oklahoma.

The seeds for these guidelines were planted in January when the College Athletic Trainers’ Society and the NCAA Sport Science Institute jointly hosted the Safety in College Football Summit in Atlanta. Attendees included athletic trainers, neurologists, team physicians, university sports medicine program directors, the American Football Coaches Association and representatives from the ACC, Big Ten, Big 12, Pac-12, SEC, Ivy League and Conference USA, among other conferences. Together, through two days of discussion, the group laid the foundation upon which these guidelines ultimately were built. And while the summit focused on football, two of the resulting documents are germane to all contact sports.

After the summit, a working group was culled from summit attendees. Their charge over the past six months has been to craft language for the documents and build consensus among relevant groups, even those that were not represented at the summit. The working group sought to introduce the guidelines in advance of preseason football activities this summer so that teams from all three divisions have an opportunity to digest the recommendations and adjust accordingly.  

“To have the NCAA, our medical professionals, coaches, school and conference administrators working collectively, speaks volumes about the desire to ensure the health and safety of our players,” said Duke University head football coach David Cutcliffe.

Though the guidelines have been released, they’re not set in stone. Because these aren’t legislated rules, there is flexibility to adjust the guidelines in real time. This is crucial because ongoing research, including a recently-announced $30 million initiative between the NCAA and Department of Defense, could reveal information that necessitates a real-time change in the approach to preventing and managing concussion, Hainline noted.

“Medicine really is a process that’s much more fluid, which led us to the guideline approach rather than pursuing legislation,” he said. “The words we like to use are ‘living, breathing.’ We’d much rather have a living, breathing document that can shift based on emerging evidence.”

Ultimately, the summit and ensuing guidelines aimed to bring the athletics community and the medical community to the same table to construct recommendations from the ground up. Early responses from coaches hint that the strategy could be effective in generating the culture shift Hainline and others crave.  

“These guidelines are strict in concept but flexible in design, allowing coaches ample freedom to design practice schedules while limiting the amount of full-contact situations that players will experience,” Montana State football coach Rob Ash said. “There is no doubt in my mind that coaching staffs across the country at all levels will enthusiastically endorse these guidelines and incorporate them into their football practice regimen.”

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