LONDON — The date is October 26, 2025, and we’re six minutes into the second quarter of an NFL game at Wembley Stadium. This isn’t just another contest in an international series, either. The league has finally put a team across the pond, the Monarchs. And running the ball, if you’re wondering, is still part of the game.
The Washington Red-White-and-Blueskins have a 1st-and-10 at the Monarchs’ 40-yard line. Both sides are set before the snap, but football looks different than it used to. Offensive linemen are squatting at the line of scrimmage, the three-point stance having been outlawed; the constant clashing of the helmets in the trenches is no longer part of the game, to reduce the number of subconcussive hits. Washington’s running back takes the handoff, plowing forward with his head down as the Monarchs’ All-Pro outside linebacker, No. 97, comes on a blitz.
The ensuing helmet-to-helmet hit is now illegal, even though it occurred inside the tackle box and behind the line of scrimmage. Back stateside a few days later, the tailback will receive the dreaded electronic notification from the NFL that he’s been fined for leading with the crown of his helmet. Like all helmet-to-helmet fines, the money will go directly to studying brain injuries through the Sports and Health Research Program at the National Institutes of Health.
Here at Wembley, No. 97 heads to the sideline. The paper-thin accelerometers embedded in his helmet have just recorded an impact of 130G on the upper left side of his head, and the data is sent to a pager-like device on the hip of the team’s athletic trainer. Was No. 97 concussed? Rather than trying to gauge his cognitive awareness through a series of memory tests as in the past, the trainers will prick No. 97’s finger with a small needle—like a diabetic checking his blood sugar—and in less than a minute they’ll know whether he has an elevated level of a protein that gets released into the blood after a brain injury.
In this instance, No. 97 was concussed.
In the locker room, he slips on a black virtual reality mask and, for the next 15 minutes his neurocognitive function is measured as he navigates a simulated playing environment. His test results are uploaded into an expanded form of the electronic medical records the NFL began using in 2013, and are easily accessible on a tablet by the team’s physician. Just as he carries his U.S. passport in Britain, so too does No. 97 carry his “neurological passport.”
The passport’s stamps are his baseline test results; his concussion history; a tally of the magnitude, location and frequency of impacts he’s sustained in practice and games, as measured by helmet sensors; the results of blood tests like the one he took on the sideline; images produced from brain scans like the one he’ll have the next morning; and his genotype (ApoE e3,e3) of a gene linked to how well a person recovers from brain injury.
An algorithm processes all this information and provides a result that will answer a question at the center of football’s present-day concussion crisis: What is the risk of No. 97 continuing to play the game?
* * *
Is any of this hypothetical scenario possible? The answer is yes, and it may happen sooner than you think.
For a week, The MMQB has explored football’s identity crisis as it tries to reconcile its inherently violent nature with the need for a safer game. While the past decade brought the issue of head injuries in football to the forefront—dozens of cases of chronic traumatic encephalopathy found in the brains of deceased gridiron stars; a concussion lawsuit that the NFL settled with former players; and President Barack Obama saying he’s unsure he’d let a son play football—the sport is now at a crossroads.
Will it fizzle and fade away? Or will it adapt and continue to grow?
The next decade will bring more answers. Each of the measures described in our look-ahead to 2025—the rules changes, the diagnostic tests, the neurological passport—have been either proposed, considered, brainstormed or researched (except for Washington’s name change, or so we think). But there is still a gap to be bridged by science and research, which takes place on a very different timetable (years) than that on which the game of football is played (days).
Concussions are distinct from other injury players sustain, and the immediate goal of team medical personnel is to diagnose and manage them based on objective data. The NFL currently uses a sideline concussion assessment that includes a symptom checklist, verbal tests of word recall and concentration, and a balance test (consistent with the 2013 Consensus Statement on Concussion in Sport). The team physician is responsible for the player’s diagnosis but has help from an athletic trainer in the press box (the “eye in the sky”), an unaffiliated neurotrauma consultant and video replays accessible on the sideline to only the medical team. There is a standardized return-to-play progression in the NFL, and discussions have started to include a more specific return-to-exercise portion, too, with details such as the heart rate that should not be exceeded in certain stages.
How will this process improve? One way is the search for a biomarker—a particular substance that could be detected in blood, saliva or urine, and that would signal that head trauma had occurred. For example, last spring a group of researchers at the University of Rochester and the Cleveland Clinic published research that showed elevated concentrations of a certain protein in the blood correlated with more hits to the head among a group of college football players.
This protein, S100B, is mainly present in the brain and spinal fluid, so increased levels in the blood show that the barrier separating the brain and the bloodstream has been opened by some kind of head trauma. At the moment a blood test for levels of this protein is best used for ruling out concussion rather than diagnosing it, and takes about an hour to yield results in an emergency room. It’s not yet a rapid yes/no sideline concussion test, but such a test might not be far off.
Changes in the brain can be quantified with the help of technology, even something as simple as a virtual reality system or an app developed by Cleveland Clinic that uses a tablet’s built-in accelerometer and gyroscope. These tests register a longer return to baseline than other widespread assessment tests like the imPACT or SCAT2. By 2025 we might see the accepted timeframe to return from a concussion increasing from a seven- to 10-day window to a few weeks, on par with a high ankle sprain.
More advanced imaging tools might also give a better window to what’s going on inside the brain, something General Electric is working toward through its $40 million research and development partnership with the NFL. Standard MRI or CT scans do not detect concussions. But a specialized scan like diffusion tensor imaging, for instance, uses water flow in the brain to show damage to the structure and connectivity of its white matter. The goal would be faster scans, tailored to people with larger body mass indices, so the morning after No. 97’s concussion he can be taken for a routine diagnostic scan, as if he had injured his knee.
* * *