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NFL Safety Improvement Football

NFL Chief Medical Officer Dr. Allen Sills gestures while speaking during a health and safety tour at Mercedes-Benz Stadium for Super Bowl 53.

Changes are in store for teams in the National Football League.

The National Athletic Trainers’ Association hosted a press conference regarding the necessity of independent medical care at the collegiate level late last month.

As the gathering in Las Vegas came to a close, the NATA and NFL hosted a media breakfast to address other concerns. During the event, NATA President Tory Lindley, MA, ATC; NFL Chief Medical Officer Allen Sills, MD; and Los Angeles Chargers Director of Football/Medical Services James Collins, ATC had a conversation about the athletic trainer’s role in protecting the health, well-being, and safety of NFL players.

They also reviewed the NFL’s and NFL Players Association’s recent initiatives regarding mental health and pain management.

Sills is a neurosurgeon in Nashville who founded the Vanderbilt Sports Concussion Center and assumed his current position in March 2017.

“I always say that (in) sports medicine, where the rubber meets the road is with athletic trainers,” he said. “To me, (athletic training) is the most vital piece of our sports medicine team.”

Perhaps two neglected pieces have been mental health and pain management.

“We’ve done a lot of work in those areas over the years,” Sills said. “It’s not like it’s new, but I think what’s new and novel is that we’re really trying to take this to a different level. So, for behavioral health, we have now mandated in conjunction with the (NFLPA) that we have a mental health clinician embedded with each team. That’s a person licensed to treat mental health disorders.”

Those individuals will be required to spend between eight and 12 hours each week at a particular team’s facility with full access to the players at all times. Sills sees their role as educators as much as clinicians. While there to assist players, who feel they need help, the mental health specialist will also be working with other medical staff, players, coaches, and management on strategies to prevent mental health issues.

“We spend a lot of time in other areas of sports medicine talking about prevention,” Sills said. “We probably haven’t focused on prevention enough when it comes to dealing with mental health.”

Sills promised complete confidentiality for the players, due to the stigma still associated with mental health.

“On the pain management side,” Sills said, “we have a joint pain management committee between the league and the player’s association. That committee will help establish standards and practices at each club about pain management and the use of prescription pain medications but also about alternatives to pain medications. And also, we’ve mandated that each club will have a pain management specialist. Then lastly, we’ll have a prescription drug monitoring program. We will analyze and gather the data on all the prescriptions generated by NFL physicians to our players and the pain management committee will get regular reports about that data to make sure that all our medicines are being appropriately prescribed and monitored.”

Collins, who is President of the Professional Football Athletic Trainer Society, emphasized that the two new programs will be collaborative rather than competitive, in order to guarantee continuity and quality of care, particularly when a player changes teams.

Lindley, who is Senior Associate Athletic Director for Health, Safety, and Performance at Northwestern University, pointed out that the athletic training profession had been much more engaged on mental health issues over the last decade at the collegiate level. As for pain management, he listed alternatives to medication that athletic trainers have used for years, such as manual therapy, therapeutic exercise, electrical stimulation and ultrasound.

Given the negative coverage the NFL has received regarding mental health issues among its players, as well as alleged misuse of pain medications by multiple teams, these new efforts should be seen as major steps in the right direction even if they are long overdue.

Yet, what good are they to players who have been recently released by a team? Where is the continuity of care, then? More importantly, what of the vast majority of football players, who play at the high school level?

Without getting into details, Sills pointed out that the NFL has programs for its retirees.

He also spoke about the impact on youth and high school players.

“One of the biggest things we can do is try to reduce stigma and reduce barriers to care," he said. "We always say football players are people first. They have the same incidence of struggles and challenges that the general population does. They just happen to have an unbelievable (athletic) skill set. There’s incredible power and opportunity when you see high profile professional athletes talk about mental health disorders, talk about their own struggles, talk about seeking care. That makes it easier, hopefully, for a youth or adolescent athlete to say, ‘Yeah, you know what? I’ve had some of those feelings. Maybe I should talk to somebody about it.’”

John Doherty is a licensed physical therapist and athletic trainer. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.

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