What the N.F.L. Says, and What It Doesn’t, About Injuries

The collapse on Monday night of Buffalo Bills safety Damar Hamlin, who went into cardiac arrest on the field in Cincinnati moments after he absorbed a hit to the head and chest, was one of the gravest N.F.L. medical crises in decades.

In a statement early Tuesday, the Bills acknowledged that Hamlin had suffered a cardiac arrest and that emergency personnel revived his heartbeat on the field. He had been sedated, the team said, and was in critical condition.

The statement was unusually candid. The health consequences of playing football and the league’s protocols for dealing with them are heavily scrutinized, but the N.F.L. and its teams typically make public only certain information about injuries.

That approach has stirred significant debate about the league’s safety record and about how much progress it has made. Especially when it comes to information about the N.F.L. in the moment, the league and its teams are largely the gatekeepers for what is said — and what isn’t.

What information does the league release?

For fans, the most familiar update on player health is the weekly injury report. For instance, before Monday’s game against the Bengals, the Bills listed Jordan Poyer as “questionable” because of a knee injury. (He was ultimately deemed available.)

But the reports, often seen as just another avenue for gamesmanship even though the league mandates that they be “credible, accurate, timely and specific,” do not detail diagnoses or say much about an injury’s severity. Instead, journalists are generally left to try to draw out answers from typically tight-lipped coaches.

The disclosures are hardly rooted in promoting health care accountability: They debuted in 1947 as a way to counter gambling.

The N.F.L. also publishes season-long data for three injuries: concussions and tears of two knee ligaments. A league spokeswoman did not respond to an inquiry Tuesday about other injury data collected by the league, but N.F.L. executives have sometimes disclosed select statistics, such as that about 75 percent of players with hamstring injuries miss time.

In 2016, The New York Times found that league studies, used in more than a dozen peer-reviewed articles, had not included more than 100 diagnosed concussions. At the time, the N.F.L. said that teams had not been required to submit data for the studies and that it had not tried “to alter or suppress the rate of concussions.”

Does the league release information about heart conditions?

Not in the data it routinely publishes.

Football players have been anxious about heart problems for decades, and researchers have long studied former players. In 2019, for instance, a study published in the Journal of the American Heart Association found that former N.F.L. players were far more likely to have atrial fibrillation than people in the general population. (The study, funded in part by the N.F.L., acknowledged shortcomings, like the possibility of recruitment bias and the absence of long-term monitoring.)

Concerns about cardiac risks extend to current players. By the 2019 regular season, the N.F.L. was worried enough about the threat of sudden cardiac arrest that it circulated an educational video to its teams.

In the presentation, Dr. Jonathan A. Drezner, the team physician for the Seattle Seahawks and the director of the Center for Sports Cardiology at the University of Washington, warned that sudden cardiac arrest was the top cause of death among exercising athletes. Most cases, he noted, occurred in basketball, football or soccer players and could often be traced to ventricular fibrillation, which renders the heart ineffective.

N.F.L. officials expected that team medical staffs would review the video annually, and doctors felt that teams should include sudden cardiac arrest in their mandatory preseason rehearsals for in-game emergencies.

The N.F.L., like other professional leagues and the N.C.A.A., was concerned in the early months of the coronavirus pandemic about the possibility of Covid-19 leading to heart troubles in athletes. In some instances, the N.F.L. recommended that players who tested positive for the virus undergo certain cardiac tests, such as an electrocardiogram, which charts electrical activity in a heart, and an echocardiogram, an ultrasound that allows doctors to evaluate visually a heart’s structure and function.

How common are concussions?

By the N.F.L.’s count, at least, they are less common than they once were. In the 2015 preseason and regular season, including practices, the league formally recorded 275 concussions, which can be challenging to diagnose. In 2021, that number declined to 187.

Concussions especially plunged in the 2018 season, after the league introduced a rule forbidding players from lowering their heads and crashing into opponents with their helmets. There were 214 that year, including preseason practices and games, down from 281 in the previous season.

The growing realization that generations of players face the consequences of head injuries, including chronic traumatic encephalopathy, a degenerative brain disease, has posed serious legal and medical threats to the N.F.L.

Are players suffering fewer knee injuries?

The data is mixed. The league reports figures only for tears of the anterior cruciate ligament and the medial collateral ligament. Both are vital to stabilizing the knee and connecting the tibia to the femur.

The 2021 season saw 71 A.C.L. tears, part of a troubling trend in a league that has seen the number of regular-season A.C.L. tears more than double since 2017. And while M.C.L. injuries have fallen from their high in 2015, when there were 160, the N.F.L. has seen increases in each of the last three seasons. In 2021, there were 129, according to the league, including 93 during regular-season games.

Ken Belson contributed reporting.

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