Injuries on NFL punts are up 50%: What's the cause? What's the fix?

Special teams plays account for 30% of ACL tears and 29% of muscle injuries to lower extremities -- even though they represent only 17% of plays in a typical NFL game. Andy Lewis/Icon Sportswire

The alarm seemed out of the blue. In the days leading up to Super Bowl LVI on Feb. 13, the NFL's health and safety team issued a call to action in response to a surge in special teams injuries, especially on punts. The rate of missed time for injuries that occurred on punt plays increased by about 50% over the past two seasons, according to league data that up until that point hadn't been widely disseminated.

"Before I go back there, I say, 'I don't care about my life.' Every time," Indianapolis Colts return man Nyheim Hines said. "It takes a special person to look up in the air and have a load of people trying to rip your head off."

Speaking in a series of interviews in February, NFL chief medical officer Dr. Allen Sills said the uptick in special teams injuries required "attention immediately" from league decision-makers. But when the NFL's owners, executives and coaches gathered in March for their annual league meetings, there was no consensus on what to do. The NFL largely tabled the concerns amid indecision from the competition committee and pushback from some coaches, who proposed that the spike -- specifically in ACL and soft-tissue injuries -- was the result of pandemic-related roster moves. Special teams plays accounted for 30% of ACL tears and 29% of muscle injuries to lower extremities -- even though they represent only 17% of plays in a typical NFL game.

Previous calls to action, particularly around concussions in 2018, heightened awareness of a high-priority problem, leading to immediate rule and protocol changes. Reported concussions have dropped about 25% since the league's 2018 call to action, but one in six occurred on special teams in 2021, according to data the league released in February. This time, the NFL is poised to play the 2022 season without addressing the issue of special teams injuries, which the league's medical staff has proclaimed to be urgent.

"It turns out," Sills said recently, "that it's a complex process."

Several coaches -- including the Pittsburgh Steelers' Mike Tomlin and the Baltimore Ravens' John Harbaugh -- suggested the injury surge could be a temporary trend attributable to unique roster management during the COVID-19 pandemic.

"I know we don't like the injury rate," Tomlin said during the meetings in March, "but it doesn't necessarily mean that something needs to be done structurally or schematically to the punt play. I think all of these discussions start first and foremost with looking at the injuries themselves, looking at the tape, the injuries that occurred on that play to see why."

NFL teams churned rosters at an historic rate during the pandemic as they worked to maintain 53-man squads amid waves of positive tests. More players appeared in at least one game during the 2021 season (2,372) than during any other season in NFL history, with the exception of the 1987 strike season, when each franchise signed an entire roster of replacement players. The second-highest total came in 2020 (2,286), according to the Elias Sports Bureau.

Harbaugh, who claimed that the spike in soft-tissue injuries such as pulled hamstrings could be lessened by better conditioning, said a rule change based on current data would be an "overreach," and added: "I don't think it's that big of a problem."

Caught in the middle of the discussion, the league's competition committee decided to sit tight and "go one more year and see where the injury data is," committee chairman Rich McKay said. That patience is likely informed by the 2018 concussion response, which included the so-called "helmet rule" -- an attempt to reduce contact with lowered heads. That proved so difficult to officiate that the league instructed referees to refer to it generically as "unnecessary roughness" when they flag it.

Even before the pandemic, however, punts had emerged as the most dangerous play in the NFL. According to league data, injuries suffered during the punt play caused the highest rate of missed games on an annual basis since the 2015 season. Returners and gunners, who are tasked with running 40 yards or more at as close to full speed as they can get, are the hardest-hit, according to Sills.

"You have athletes running over long distances," said Dr. Scott Rodeo, a sports medicine surgeon at the Hospital for Special Surgery and head team physician for the New York Giants. "They're running at high speeds, with a rapid plant and cut, decelerations in the open field, and sometimes it's reckless. When you're running at very high speeds and have collisions at high speed, that's a pretty good working theory right there."

Both Rodeo and Sills are optimistic about actions the league can take to lower the ACL-injury rate on punts. Rodeo is monitoring research that could help identify players who are at risk of knee ligament tears, determined by factors that include abnormal geometry of the knee as well as deficits in balance, coordination and neuromuscular control in the hip and core areas. Applying that research with various conditioning techniques, protective equipment and "subtle rule changes," Rodeo said, would "give me some optimism that you can start to solve this problem by chipping away at it."

The competition committee is monitoring a rule adjustment the USFL implemented in its inaugural season. Gunners are required to line up inside the painted numbers, making it easier to block them at the line of scrimmage and perhaps tougher for them to reach maximum speed. There could be other ways to minimize the amount of space gunners cover and the speed at which they do it, but ultimately, Sills said, "You always want to make sure that your solution addresses the problem."

At this point, not everyone has agreed there is a problem. And for unrelated reasons, there are already fewer punts in NFL games. As coaches shift toward going for it on fourth downs more frequently, punt totals have fallen to historic lows. The rates of punts per game in 2019 (8.4), 2020 (7.4) and 2021 (7.6) are the three lowest for a season since at least 1981, according to NFL data.

If anything, the decrease makes the injury trend more stark. If the injury rate continues in 2022, the NFL will have decisions to make in 2023.

"It's a complex play, but those are the types of injuries and where we're seeing them," Sills said. "And we're going to continue [working] on that play. The fact that it's difficult doesn't mean we're not going to continue to address it."

Contributing: ESPN Colts reporter Mike Wells