The Impact of the Helmet-Lowering Rule on Regular Season NFL Injuries

OBJECTIVES: The National Football League (NFL) has been under growing scrutiny from the public due to the apparent rise in concussions and head injuries and the subsequent deleterious effects. In efforts to address these concerns, the NFL implemented a new “Helmet-lowering” rule prior to the 2018-2019 season. This rule is defined as “a foul if a player lowers his head to initiate and make contact with his helmet against an opponent.” The purpose of this paper was to compare incidence of injuries in NFL players prior to and after implementation of this new rule. METHODS: NFL injury data was retrospectively reviewed from public league records for all players in regular season games played from the 2017 and 2018 NFL seasons. An injury was defined as any player listed on a team’s injury report that was not previously documented on the team’s report one week preceding the index injury. Injury rates were reported as the number of injuries per 1000 athletic exposures (AE’s). Athletic exposures were defined as equal to the sum of the total number of NFL regular-season games played. Relative risk (with 95% CI) was calculated by using the number of injuries per 1000 athletic exposures for the season before and after the new rule implementation. Risk reduction was then calculated for the overall injuries, upper/lower extremity and head injuries. RESULTS: Over the 2 seasons there were a total of 2,774 injuries identified. After rule implementation at the beginning of the 2018 season, there was an overall relative risk (RR) of 0.91 for injury (95% CI 0.88 to 0.95, p<0.0001), with an injury risk reduction of 8.73%. Upper extremity injuries had a RR of 0.76 (95% CI 0.65 to 0.87, p=0.0005) and a risk reduction of 24.10%. Lower extremity injuries had a RR of 0.91 (95% CI 0.87 to 0.96, p=0.0005) with a risk reduction of 8.63%. In concussions and head injuries there was an overall RR of 0.55 for injury (95% CI 0.44 to 0.69, p<0.0001), with an injury risk reduction of 45.10%. Wide receivers and linebackers were most commonly injured players on offense and defense, respectively. CONCLUSION: Implementation of the new Helmet-Lowering rule seems to have played a role in significantly decreasing the NFL athlete’s risk of injury across all measures, most notably in concussion and head injuries.