Allow flexibility, recognize variables

The recommendations were designed to allow flexibility for state associations that collectively oversee the more than 15,000 high schools across the country that have football programs.

The teams fielded by these schools may vary tremendously in the number of available players. Team size dictates numerous variables that may affect an athlete's potential head impact exposure. Those variables cannot be easily accounted for by stringent guidelines.

For example:

• An athlete playing on offense, defense and special teams will have greater cumulative head impact exposure and will be at higher risk for injury than an athlete playing a single position.
• The fewer the number of players on a team, the greater the chance some players will need to participate in repeated drills, raising head impact exposure and potential injury risk.

Based on what is currently known, the guiding principles in developing the report for young athletes and those who oversee, support and administer high school football programs were to reasonably limit overall exposure to multiple blows to the head and body (head impact exposure) and minimize concussion risk, while maintaining the integrity of the game and attempting to avoid unintended consequences.

As additional evidence emerges, NFHS said that its guidelines will evolve, and may become more or less restrictive. While the current level of knowledge kept the task force from making proposals that are specific and rigid, there is consensus that lessening the frequency of contact (and thus head impact exposure) is likely beneficial to overall brain health.

Many variables effect head impact exposure

The task force also recognized that multiple contributing factors that affect head impact exposure and the parallel effects on an individual football player's brain, including: 

• Position played (linemen receive more total blows than other positions)
• Two-way players versus those who only play offense or defense
• Tackling and blocking techniques
• Practice frequency and duration
• Players who practice and/or compete on multiple levels (such as varsity and sub-varsity)*
• Concussion history
• Genetic predisposition to concussion

*Note: This contributing factor was added to the document by the NFHS SMAC.

Every athlete is unique

It is very likely that each athlete has a unique level of resilience or susceptibility to concussion and further brain injury. While there is currently no definitive way to measure or quantify this resilience or susceptibility, the task force recommended reasonably limiting head impact exposure through the Fundamentals. Individual risk factors that are modifiable, such as position played, total time spent on field, and sport technique, must be also considered when implementing contact limitations, it said.

Minimizing risk

The Concussion Summit was the latest effort by the NFHS to minimize risk for the almost 7.8 million student participants in high school sports. In 2008, the SMAC advocated that a concussed athlete be removed from play and not allowed to play on the same day (a rule adopted as law by nearly every state since May 2009, at least at the high school level).

For the past six years, all NFHS rules publications have contained guidelines for the management of a student exhibiting signs, symptoms or behaviors consistent with a concussion. In 2010, the NFHS developed on online course - "Concussion in Sports - What You Need to Know" - and about 2 million individuals have taken the course through the NFHS Coach Education Program.Some states had already adopted similar limitations in previous years.

More states adopting contact limits 

In 2013, Texas began limiting its players to 90 minutes of full-contact practice per week during the regular season and postseason. Preliminary High School RIO injury surveillance data suggest that the new policy resulted in a statistically significant decrease in concussion rates during practices, and similar results were seen in Arizona, Maryland and Alabama after comparable changes were made to practice rules in those states.

The task force designed its recommendations to be flexible for state associations as they adopted their own requirements. In the months leading up to the 2015 fall season, some state associations adopted the recommendations exactly, while others altered them to more closely fit the needs of their member schools:

• the state associations in Iowa, Kansas, Georgia and Tennessee opted to limit full-contact practice to 90 minutes a week. 
• Other states, such as Ohio, chose to limit full-contact to 60 minutes a week instead. 

That flexibility was an important part of the recommendations according to many state association administrators across the country.

"Our committee was able to adjust some things so the recommendations would be a better fit for our schedule," said Mark Lentz, assistant executive director and administrator for football at the Kansas State High School Activities Association (KSHSAA).

The KSHSAA has been one of many state associations to make changes to its football rules that went beyond the recommendations of the task force. For example, players in Kansas will no longer be able to participate in "Live Action" the day after a game. And, effective with the 2016 season, they will not be allowed to participate in games on consecutive days. That change was made to address the issue of student-athletes playing a varsity game followed by a junior varsity game the next day, Lentz said.