Does targeting rule protect football players?

The NCAA adopted the targeting rule in 2008 to try to decrease head injuries in football. (File/AP/Steve Helber)

If you’ve watched college football over the last few seasons, you probably have seen a scenario like this one.

One team is moving the ball down the field in a tight game. The quarterback throws a pass over the middle of the field to a wide receiver who stretches out to catch it. The safety launches his body at the receiver, knocking him to the ground. A referee throws a flag in the air and calls a targeting penalty. Fans of the penalized team boo loudly. The television commentators spend minutes arguing whether it should be a penalty after watching replays in slow motion from multiple camera angles.

In February, the NCAA took steps to address concerns about targeting penalties. After a four-day meeting in Orlando, Fla., the NCAA Football Rules Committee decided to allow the instant replay official to review every aspect of a targeting penalty. The replay official could also stop the game if he witnesses an obvious violation missed by officials on the field.

The chair of the committee, Bob Nielson, who also serves as head coach at the University of South Dakota, believes the rule is working. “The targeting rule is serving the game well, and has enhanced player safety,” Nielson said in a statement on the NCAA’s website.

Fans might criticize these penalties and ask whether they are making the game less appealing to watch. Coaches can debate what actually constitutes a targeting penalty. It’s worth asking a more fundamental question.

Does the targeting rule actually do what it’s supposed to do — protect the health of the players?

The targeting rule bans an athlete from hitting a defenseless player above the shoulders or delivering a hit with the crown of his helmet. The NCAA adopted the rule in 2008 to try to decrease head injuries in the sport. Initially a targeting call only produced a 15-yard penalty. In 2013, the NCAA toughened its stance by ejecting the guilty player from the game.

In the season prior to the automatic disqualification of players called for targeting, officials called 99 penalties, or roughly one in every eight games, according to the New York Times. In the first part of the 2013 season, referees called one penalty for every 10 games.

It seems likely that players actually changed their behaviors to avoid the penalty. Instead of aiming for an opponent’s head, the defender might aim lower on the body. Unfortunately, it seems that the change in tackling technique might be creating other problems.

Robert Westermann, M.D. recently presented the results of a study on injuries before and after the NCAA rules went into effect. He and his colleagues at the University of Iowa analyzed the incidence of both concussions and lower extremity injuries (thigh, leg, ankle and foot) that occurred in 48 NCAA football teams between 2009 and 2014.

They found that the rate of lower extremity injuries increased from 9.45 per 1000 athlete-exposures (one practice or one game) in the 2009-2010 season to 12.63 injuries for 1000 athlete-exposures in the 2013-2014 season. A majority of those were knee or ankle injuries, and 59 percent were caused by player contact.

Worse yet, the rate of concussions did not decrease. In fact, concussions increased slightly over that time. 1.64 concussions occurred for every 1000 athlete-exposures in 2009-2010, but 2.87 concussions per 1000 athlete-exposures occurred in 2013-2014.

“Nearly a third of all concussions in collegiate athletics occur during football,” Dr. Westermann said in a press release. “With the relatively recent rule changes, concussion rates have not decreased. Our analysis of the NCAA Injury Surveillance Database though noted increased rates of ankle and knee injuries, which may result in osteoarthritis and disability issues later in life for these athletes. Athletes may be making contact lower on the body, to avoid the head-to-head contact and thus stiffer game penalties.”

Westermann is correct that many of these injuries cause long-term disability. ACL tears, sprained ankles and broken legs can lead to arthritis and lingering pain as the athletes get older. Time and much more research will tell us if we are truly protecting athletes or just trading one injury with long-term consequences for other ones.

Dr. David Geier is an orthopaedic surgeon in Charleston. For more information about football injuries and other sports medicine topics, go to drdavidgeier.com.