At every game, the Michigan State football team steps onto the field armored in some of the most carefully engineered equipment in the sport’s history. While many players’ worst fears include suffering an injury during a critical moment in a game, the truth is that the risk of head injury is actually highest during practice.
“Most concussions occur in practice because you have it four or five times a week,” said Dr. David Kaufman, a professor of neurology and ophthalmology at MSU and a neurologist for the football team. “You have 44 people on the field instead of 11, so the number of collisions is much higher.”
Football has evolved over the years, and so has its equipment. As awareness about concussions and long-term neurological conditions such as second impact syndrome and chronic traumatic encephalopathy, or CTE, grows, so does the push for better safety gear. New helmet technologies, combined with updated training protocols, are all part of a larger mission: protect athletes’ brains without sacrificing the spirit of the game.
Kaufman said the revolution in how head injuries are understood and managed began at the start of the 21st century, during a period he calls the "concussion crisis." Research from pathologists like Dr. Bennet Omalu and Dr. Ann McKee at Boston University uncovered evidence that repetitive head trauma could lead to serious, long-term neurological damage, even in athletes who wore helmets throughout their careers.
“They began seeing the same thing, and they invested in the term chronic traumatic encephalopathy,” Kaufman said. “The evidence that this disease occurred became overwhelming, and during the first decade of this century further studies were done, congressional meetings were held, interactions and then lawsuits regarding the National Football League emerged.”
One of the most attention-grabbing studies came in 2017, when researchers at Boston University published findings in the Journal of the American Medical Association. In that study, scientists diagnosed CTE in 99 percent of NFL players' brains they examined, 91 percent of college football players and 21 percent of high school players.
Kaufman said that while the findings were striking, they needed to be understood in context.
“What was not highlighted or understood by the lay press or sportswriters was the fact that this was a biased sample of people from families that realized there was something going on regarding their loved one,” he said.
The families most likely to donate players’ brains were already concerned about symptoms, a factor that could skew the results.
“The lay press got hold of this, declared football an absolutely dangerous sport. And although they're not wrong, the risk of CTE may not be anywhere near the epidemiology that was being claimed after all,” Kaufman said. “Think of all the people that play soccer, rugby, ice hockey, football and other collision sports that do not have clinically relevant CTE. That part wasn't noted.”
Even so, the wave of new research triggered a reckoning across the sport and a renewed focus on player safety.
Modern helmet designs now focus less on making shells harder and more on dispersing impact forces. Flexible shells, multilayered cushioning, and impact-dispersing materials aim to reduce brain movement during collisions.
“If you're talking to a physicist or engineer, they would explain that the key is to disperse force,” Kaufman said. “Making a helmet harder is actually counterintuitive. A hard helmet isn't as effective as a soft helmet.”
While football equipment has improved, Kaufman emphasized that helmets alone cannot prevent all brain injuries, especially those caused by rapid deceleration inside the skull.
“The brain itself has the consistency of an egg yolk,” he said. “No matter how good the helmet, you can still get a deceleration injury where the brain sloshes and hits the inside of the skull.”
At practices, Michigan State players also wear Guardian Caps, padded outer shells placed over their helmets. These technologies are critical, especially during high-contact practices where more collisions occur compared to games.
But while technology and equipment have improved, Kaufman stressed that closely monitoring players for signs of concussion is vital to preventing more serious injury. Athletes are often reluctant to report symptoms, which can lead to dangerous situations, such as second impact syndrome, where a player suffers a second concussion before recovering from the first.
“Second impact syndrome is potentially very dangerous,” Kaufman said. “That's why the diagnosis of concussion needs to be made. Players need to be disciplined enough to realize that they're not going to do well on the field if they're concussed, and they have to be willing to point it out.”
At MSU, players are taught to watch for signs of concussion in themselves and in each other. Kaufman shared an example of how teammates can spot potential concussions.
"Connor Cook, a player of considerable value to the team, comes over to me and says, ‘Y'know, our fullback is talking about his calculus equations … but he’s not taking math this semester,’" recalled Kaufman. "Fellow players and coaches also have to look for changes in personality, cognitive disturbances, memory, and deranged thoughts like what happened in this case."
Recovering from a concussion doesn’t just mean resting until the symptoms reduce. Kaufman emphasized that easing players back into academic work, what he calls "return to learn", is just as important as the athletic recovery process.
"Everybody understands return to play," Kaufman said. "It's return to learn that sometimes can cause problems."
A concussed player forced back into a heavy class schedule too quickly can experience setbacks that prolong brain recovery. At MSU, athletes' course loads and academic demands are carefully managed following a concussion to avoid these issues.
While concussions cannot be cured, symptoms like headaches, dizziness, mood swings, and memory problems are closely monitored and treated individually.
Along with evolving equipment standards and education, rule changes at both the NCAA and NFL levels have also made a difference.
Kickoff returns, once a major source of violent collisions, have been restructured to minimize high-speed impacts. Targeting penalties for helmet-to-helmet hits have become more severe, including possible ejections for players.
“The rule changes that are here, they help reduce the number of concussions but do not end it,” Kaufman said. “But it’s making it safer.”