Adam’s Journal
Just before the National Football League season kicked off, a new study came out about brain injuries in former NFL players. It painted a grim picture.
Today, players are wearing protective equipment like Guardian caps and neck devices to prevent concussions and other brain injuries. Do they help? Is there any way to protect the brain from injury in a game with as much contact as football?
Dr. Scofield Prescribes
The study you’re talking about, published in August in BMJ, the British Medical Journal, looked at brains of former NFL players. All the brains had been donated by players or their families. For those who’d died most recently – from 2016-2021 – researchers were able to examine the brains of roughly one-quarter of all former players who’d passed away during that period.
The researchers found that of those brains, more than 97% had chronic traumatic encephalopathy, or CTE, a brain disease caused by repeated head trauma. In its most severe form, CTE is almost always accompanied by dementia.
These figures don’t mean that 97% of all NFL players will develop CTE or dementia. The group that donated their brains – or whose family members did – was self-selecting, as most had experienced symptoms of brain disease while living.
Still, the prevalence was startling, as CTE is nearly non-existent when measured across the general population. At a minimum, it indicated that nearly 25% of former NFL players had CTE. And the real numbers were likely much higher, as that figure assumes that none of the others who died during that time had CTE.
Unfortunately, when it comes to football, CTE isn’t limited to former pros.
Research has found that CTE risk increases with cumulative exposure to repeated head impacts. Many of these are sub-concussive blows, meaning they never cause a diagnosed concussion. Examination of brains of former players at all levels found that every additional year of football increased the odds of CTE by 30%.
Guardian Caps are the soft padded covers you’re increasingly seeing over players’ helmets. It would seem the extra layer could absorb collision energy, and the NFL reported in 2024 initial data that showed a 52% decline in concussions among players who wore them in preseason compared with previous averages.
But when researchers restricted the analysis to concussions involving impact to the helmet shell, which is where you’d presume the Guardian Cap would offer protection, the effect disappeared. A study of 2,600 high-school football players likewise found no significant reduction. And an analysis of 7,500 actual impacts experienced by college players – measured by instrumentation in players’ mouthguards – showed no significant reduction in force.
Sadly, the data is similarly questionable when it comes to the Q-Collar, the band that some players wear around their necks. The collar applies gentle pressure to the jugular vein, slightly increasing the amount of blood in the skull. Theoretically, this could reduce the brain’s “sloshing” against the skull during impacts.
Even though the FDA authorized marketing the device in 2021, the study underlying that approval didn’t demonstrate that Q-Collars prevent concussions or serious brain injuries. And a follow-up investigation in BMJ raised substantial questions about both the study design and statistical analyses.
If we want to protect those who play football, it’s becoming increasingly clear that no device will be the answer. That’s because no matter how much protection players have around their heads (or necks), the brain will still move inside the skull.
The key to preventing brain injuries is reducing total head-impact exposure. That means measures like fewer full-contact practices, fewer hits in practice – and starting kids in tackle football at later ages.
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Dr. Hal Scofield is a physician-scientist at the Oklahoma Medical Research Foundation, and he also serves as Associate Chief of Staff for Research at the Oklahoma City VA Medical Center. Adam Cohen is OMRF’s senior vice president and general counsel. Send your health questions to contact@omrf.org.
