Why low hits are now bringing the NFL to its knees

They don’t come any bigger – in reputation at least – than Tom Brady. With his decade and a half of calling the shots for the New England Patriots and four Super Bowl rings decorating his fingers, this is a giant of the sport, a genuine all-time great in an era when claims of greatness are too easily made. This is a 38-year-old who has been there, done that and delivered the decisive pass time after time, a man who deserves to be listened to.

Two weeks ago the quarterback watched Rob Gronkowski, one of his go-to men, carted from the field late on. “The Gronk”, as the Colossus of a tight-end is known, had his legs swept away by Denver’s Darian Stewart. Memories of last December flooded back, when Gronkowski was reduced to tears after suffering a knee injury that threatened his livelihood.

This time he was more fortunate, although he remains on the sidelines – another footballer nursing a wounded knee. This week’s absentee lists across the NFL has 359 players out through injury or suspension; 82 with knee problems, nearly double the next most common complaint. Twenty six are missing through concussion. Here is the issue that has become the talk of the locker room over the last few years. Would you take a hit to the head or a hit to the knee? And has the focus on protecting the head – which has been proved potentially life-threatening – meant the knee is now taking the strain?

Brady was asked after the Denver game whether rules introduced over the last five years in an attempt to limit the number of concussions have led to teams switching tackling tactics, aiming low where they would have once gone high.

“I hate to see it but it’s really the only way for the defence to hit now, so…” he said and then shrugged. “I bet if you asked a lot of the players they would probably say they’d rather you go high than low. When you go low that’s what happens.

“You hate to see one of your guys take hits and I do think they should change some of those rules with defenceless receivers.”

Brady’s is not a lone voice and there are many who will have nodded along with what he said. As Michael Bush of the Chicago Bears put it last year: “If you get hit in the knee, that’s your career.”

Tackling has changed markedly since the 1980s, when wrapping up an opponent was the preferred method. Instead, in the 2000s, it has become about hits, bone-jarring collisions. When the rule changes began in 2010 as the NFL belatedly addressed its serious problem with head injuries and their consequences – introducing restrictions on hits to shoulders and heads – players were quick to point out where that would lead.

“Guys are going to be fearful of being fined so they’re going to start going at the knees,” forecast LaMarr Woodley of the Steelers. “That’s going to be a serious problem, knees being blown out, mess up the way they walk for the rest of their lives.”

For some it is a black and white issue. Take a bad hit in the knee and you know about it, excruciating pain, the operating table and possibly the immediate end to your career. Head injuries come in shades of grey – the latest reports suggest it is not the big hits that necessarily lead to chronic traumatic encephalopathy (CTE) but rather the totting up of blow after blow across the course of a career. They go almost unnoticed by the recipient – these are tough men – and it is not until helmets are hung up that the sometimes lethal effects are realised. According to data gathered between 2000 and 2014, knee problems keep players out for longer than any other injury. Between 2002 and 2012 there were an average of 43 anterior cruciate ligament (ACL) related injuries per season. In 2013 that rose to 65 and stuck at that level in 2014. Concussions, meanwhile, have fallen – from 2012 to 2015 they dropped 35 per cent.

When Gronkowski was taken out low by Cleveland safety TJ Ward last year he tore right anterior cruciate and medial collateral ligaments. It threatened his future and there were plenty who suggested it was caused by rule changes.

Gronkowski is 6ft 5in and Denver were accused two weeks ago of deliberately going low having spent much of the game bouncing off his upper body. Players, as in rugby, are getting bigger, stronger, faster and so more difficult to stop. That is one reason advanced for the rash of knee injuries, another is the shorter pre-season teams now undertake in order to limit the wear and tear on players’ bodies – instead, some claim, it leaves those bodies inadequately prepared for the season once the hits start raining in. Changes in footwear that have led to lightweight shoes designed for speed as well as different turf are also cited as contributory factors.

Others point to the concussion rules, believing it pushes the focus from high to low. The latest change aims to protect offensive players attempting to catch an intercepted ball – they “cannot be hit in the head or neck area”. The only choice is to go low.

“It wouldn’t be surprising to see the NFL attempt to add rule protection for lower body injuries,” said Jene Bramel, a doctor and writer on the NFL for the website footballguys.com. “Hitting a quarterback below the knee in the pocket is a penalty. But narrowing the target area for defenders playing at speed is easier written into the rule book than accomplished on the field.”

For the NFL, who two years ago reached a £477m settlement with up to 4,500 former players after being accused of having misled them on the dangers of head injuries, concussion remains the No 1 concern. It is a live issue. In September a study found 87 out of 91 former NFL players tested had a brain disease linked to concussions received during their careers. This week Bennet Omalu, the forensic pathologist and neuropathologist who first discovered CTE in football players, wrote in The New York Times that all children under 18 should be banned from playing high-impact sports like football. He compared playing them to letting your children drink alcohol or smoke. A film, starring Will Smith as Omalu, documenting the doctor’s campaign opens in the US on Christmas Day.

The data around concussion is conclusive. That around the cause of knee injuries is not. For example, Reggie Bush, the 49ers running back, recently tore his ACL after slipping on the concrete surrounds of the field of play in St Louis. There has also been a spate of ACL injuries suffered in pre-season, few of which have involved contact.

Whatever the rules this is a brutal sport. On the first weekend of November the injury count reached 32, many serious. “Speed and size play a role in injury, but football is much more than a contact sport,” said Bramel. “Some refer to it as a collision sport, but it’s really supervised trauma. The force and location of impacts during the game can cause injuries similar to those seen in car accidents or falls. Part of the allure of football has always been the combination of power and athleticism. With that comes the risk of violent impact.”

Brady’s calls deserve to be considered but the overwhelming priority remains to protect the head. After that the sport has to decide how much it wants to change.

“The nature of the game is violence,” was how Walter Thurmond of the Seattle Seahawks bluntly summed it up last year, “and it’s been about that since its creation.”