Damar Hamlin's collapse is a reminder that football can be 'extremely ugly'
Monday night's game between the Buffalo Bills and Cincinnati Bengals was set to be a barnburner, as two of the top teams in the NFL competed with playoff implications on the line. But before the game got through its first quarter, Bills safety Damar Hamlin collapsed on the field, just moments after tackling Bengals wide receiver Tee Higgins.
As both teams and the crowd watched in horror, Hamlin was treated with CPR for several minutes before being rushed to the hospital. In a statement, the NFL said that Hamlin, 24, had suffered cardiac arrest and was in critical condition. (He remains hospitalized as of Friday afternoon, but the Bills say he is "neurologically intact" and able to talk with family and teammates.)
Hamlin's collapse was a jarring moment for the league, its players, and the fans watching at home. At times, NFL injuries can feel somewhat commonplace. There's a routine, an order, that often follows a devastating play: replays being shown or not shown depending on the severity of the injury, and the cool, flat voice of a play-by-play announcer as the injured player is helped off the field by a trainer, or worse, carted away with a thumbs-up to crowd applause.
Hamlin's injury, however, was different. ESPN cut to one commercial break, then another, then another. There was no progress, no update, and no thumbs-up. The game was suspended. As coaches, players, and fans made their way to the University of Cincinnati Medical Center to pray for Hamlin and donations flooded, into the millions, into a toy drive he'd once organized, commentators reflected on football's inherent dangers.
"Tonight we got to see a side of football that is extremely ugly," player-turned-commentator Ryan Clark said on ESPN. "A side of football that no one ever wants to see, and never wants to admit exists."
Hamlin's injury appears to have been something of a fluke — a hard-hitting, but routine play that triggered a possible arrhythmia. But it provided a stark reminder that the NFL is full of "routine" injuries that come with a heavy cost. Heading into Week 17 of the 2023 season, 135 players across the league had been reported with concussions, including 18 in Week 4 alone.
Their ranks include Dolphins quarterback Tua Tagovailoa, who has suffered multiple concussions this season — including one particularly scary one — leaving his playing status for the postseason in doubt.
As NFL players continue to grow faster, stronger, and more exacting, the sport has gotten more dangerous. While the league has made some changes to help protect the most exposed players and more aggressively treat possible concussions, there's a limit to just how safe football can get — unless it's changed altogether.
Football poses a number of serious health risks to players
All pro athletes are prone to injuries and accidents. But unlike basketball players, whose injuries tend to be incidental or non-contact, or gymnasts, whose dangers derive from their own control over their bodies (or lack thereof), American football players "deliberately collide together," Dr. Joan Rubinger, an independent sports medicine doctor who's worked with NFL players for 12 years, told Insider.
The physical and mental repercussions are plentiful, well-known, and long-lived. Head injuries like concussions are common, and repeated blows can lead to chronic traumatic encephalopathy, or CTE, a degenerative brain condition often marked by aggression, depression, memory problems, and impaired judgment. Longer-term, it can promote early-onset dementia and has been associated with multiple NFL athletes' suicides.
There's also the chronic pain afflicting current and retired NFL athletes, due to muscle overuse and musculoskeletal injuries. It's a condition that can have cascading consequences, like opioid overuse, depression, and aggression.
Obesity-related illnesses like hypertension and sleep apnea also plague some NFL retirees. Linemen, in particular, can see their size can go from a game-winning asset to a health liability overnight.
"You want to pile on with the steaks, pastas, the heavy stuff," former defensive lineman Michael Dean Perry told The Athletic. "And you have to retrain your brain to eat more vegetables, more protein, more baked meats. It's an ongoing process, a daily battle."
One study found the median age of death for NFL athletes is 59 or 60, often driven by neurodegenerative and cardiovascular decline.
"It's a brutal sport, and these men are absolute gladiators for going out there and doing what they do on a daily basis," Rubinger said. "The fans do not have a clue as to what these men put their body through. They just don't see that this is a 24/7 thing for these guys."
The NFL has made some moves to address the risks posed to players
The NFL is aware of the risks that come with playing football. In 2013, the league reached a settlement worth $765 million with ex-players that had accused it of concealing the dangers of concussions. Since then, the NFL has been more proactive about changing rules to make the sport safer, particularly with regard to preventing concussions and head injuries.
The quarterback, who can often be exposed to a defender he doesn't see, is better protected thanks to rule changes around roughing the passer. Defenders now "must strive to fall to the side of the quarterback's body, or to brace his fall with his arms to avoid landing on the quarterback with all or most of his body weight." The rule is so well-enforced that it can sometimes be difficult for defenders to bring a quarterback down without getting flagged.
Another focus has been enforcing targeting, the rule that protects players deemed "defenseless" during a play, in order to discourage helmet-to-helmet contact that can lead to head and neck injuries. Targeting can now come not only with a 15-yard penalty, but with fines or even a suspension, if deemed necessary by the league commissioner.
The definition of who qualifies as a "defenseless player," meanwhile, has repeatedly expanded to include more players, including receivers just after a catch, quarterbacks after a change of possession, kick returners and punt returners, kickers, punters, and long snappers.
According to data from the NFL, there's reason to believe that these changes have helped. In 2015, the league recorded 275 concussions through the preseason and regular season, but that number has trended down since, with 187 concussions in 2021.
The league has also been experimenting with new protective measures. Ahead of the 2022 season, players wore guardian caps — a padded, soft-shell cover — over their helmets during training camp. The NFL said that the caps led to a drop in concussions, but it hasn't taken any steps to mandate them, instead saying that it will continue to collect feedback from players, coaches and equipment managers this off-season.
The league could potentially make small changes that would prevent injuries
But despite these changes, Rubinger says the league and its teams still aren't doing enough to prioritize athletes' full-body health over profit and wins.
"The small 'moves' that the NFL has made to show that they are trying to improve player safety are not moving the needle," she said. "It's maybe too little, too late."
She added that players often seek her and other independent clinicians out because they're afraid that admitting pain to team doctors will compromise their contracts. "From what the athletes explain," she said, "the team will always do what suits the team's needs."
There are some additional adjustments the NFL could conceivably make that could help make the game safer, while not entirely changing it.
Kickoffs have long been known as especially dangerous, essentially sending a lone ball carrier headlong into an oncoming wave of 200-plus-pound bodies. College football and the NFL have both made changes to encourage more teams to take touchbacks and avoid returning the ball in the field, but some teams are always going to believe that if they have the opportunity to return a kick, it could go for a touchdown.
The NFL could potentially follow in the footsteps of other football leagues that have taken further steps to address kickoffs. In the renewed USFL, which is set to start its second season this spring, at least eight players on the receiving team must remain between their 35- and 45-yard lines, leaving less room between opposing players before contact is made. The short-lived American Alliance of Football, or AAF, went a step further: It eliminated kickoffs altogether, instead starting with possession at the 25-yard line.
The league could make adjustments off the field as well, allowing players more time to recover in between games. Currently, teams play 17 regular-season games, with just one bye week. The addition of a second, or even third, bye week could give teams more time to treat injured players and promote rest for the relatively healthy ones. The NFL could also expand the size of teams' rosters, which might encourage injured players to stay out until they are fully ready to play again.
Taking that idea further, if the NFL is set on expanding the regular season to 18 games, as has been reported, the league could both expand rosters and limit the number of games in which an individual player is allowed to appear. This seems doubtful, as the league would not want high-profile players potentially forced to sit out high-stakes games, but it's an idea.
With the NFL's big financial stakes, more dramatic changes will be hard to come by
From there, the proposals get more drastic, and more unlikely. Arguments have been made that the elimination of helmets would actually lead to fewer concussions, as players would no longer even have the option of using their head as a weapon. The result would look closer to rugby, but there are already football leagues that have tried it out — the A7FL is a seven-on-seven league that plays without helmets or pads, but remains full-contact.
Finally, there's the idea of eliminating tackle football altogether, and switching to flag football.
"Flag is the future of football," Troy Vincent, the NFL's executive VP of football operations, wrote in an October op-ed pushing to add the sport to the Summer Olympics. From 2015 to 2018, the number of 6-to-12-year-olds playing flag football rose to 1.5 million, a 38% increase, according to a Sports & Fitness Industry Association study. That's nearly 100,000 more players than participated in tackle football, the study found.
If parents and their kids keep shifting away from tackle football and into flag football, it could eventually impact the league's talent pipeline and priorities.
But at the moment, a switch is unlikely, given the current stakeholders and appetite for tackle football. Even as television ratings decline across the board, the NFL draws huge viewership. And a freshly minted $100 billion rights deal with broadcasters and streaming companies means a drastic change is unlikely to come any time soon.
Tackle football will always carry inherent risks
In the NFL as it is currently constructed, minor adjustments may help make the game safer. But ultimately, "it's like trying to make a safe cigarette," commentator Bomani Jones said on CNN after Hamlin's injury. "It's just not really how this works, how this game works, and part of why people watch is the fact that it's not safe.
"We always try to come around and find a way to be like, 'Man, do you think they can find a way to make this safe?' No, they can't," Jones continued. "That's just not what this game is or what it's ever going to be."
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