“It was basically an eye opener for so many parents who have children who love football. Parents might be a little bit more hesitant wanting their child to play if that’s going to happen. It’s unreal.”

Harry Carson, Former Linebacker, New York Giants, on Damar Hamlin injury

On the New Year holiday, while the country was enjoying a half-century-old mass ritual known as Monday Night Football, millions of people – myself included – were left watching Buffalo Bills safety Damar Hamlin fighting for his life near the 50-yard line. As we pray for his recovery, it’s appropriate to ask ourselves: can we, in good conscience, keep embracing this game? And, is there a better way to use real-time technology to monitor the health of athletes in all areas of sport?

People have been wrestling with this question for over a decade, as science has shed light on football’s health consequences. Chronic traumatic encephalopathy (CTE) was once an obscure entry in medical textbooks. Now, it’s the neurological disease associated with repeated blows to the head, known for afflicting more than 300 former NFL players and perhaps hundreds more (the condition can only be definitively diagnosed post-mortem).

And Hamlin’s injury is just the most recent example. Hamlin’s injury occurred mere months after Miami Dolphins quarterback Tua Tagovailoa suffered a gruesome concussion-related event when he began seizing on the field following a play—which occurred just weeks after he collapsed due to a separate concussion following a brutal hit in an early season game. In the preseason, the NFL finally tested new helmets designed to prevent concussions. Reports from the league suggest they were effective, but no move has been made to require them in the regular or postseason.

While Hamlin didn’t suffer a head injury (many medical experts suspect his heart stopped due to commotio cordis, an extremely rare but sometimes fatal disruption to heart rhythm resulting from a blow to the chest), it raises the issue of whether real-time monitoring technology can be used more effectively to prevent severe injuries from occurring during games.

A recent peer-reviewed study demonstrates the feasibility of utilizing medical-grade sensors for collecting and monitoring real-time digital biomarkers on elite athletes in live competitions. The peer-reviewed study, Real-time Digital Biometric Monitoring During Elite Athletic Competition: System Feasibility with a Wearable Medical-Grade Sensor, was conducted in professional squash matches in 2019-2020 in cooperation with the Professional Squash Association. The findings demonstrated the capability to reliably capture clinically valid data from medical-grade wearable sensors on athletes exhibiting extreme motion and supraphysiologic characteristics in live competition.

In professional team sports, collecting and analyzing athlete-monitoring data are standard practices to assess fatigue and subsequent adaptation responses, examine performance potential, and minimize the risk of injury or illness. GPS trackers sewn into athletic uniforms feed back real-time information on NFL players’ balance, speed, acceleration, and motion. Early signs of injury to soft tissues are readily detected, letting coaches relieve players before serious problems arise. Impact monitor stickers attached to players’ bodies alert coaches and trainers to invisible signs of potential concussion, brain trauma, over-exertion, or injured muscles, tendons, and ligaments.

But that assessment happens during practice sessions and during the recovery period following the actual game itself. The groundwork has been done with the NFL linking up with Zebra Technologies to add monitoring tags to the shoulder pads of all players. The real game-changer will be when this data is made available to coaches during live matches. Is there a case to be made that real-time monitoring should be incorporated into the game? I think we’re at a point where the usual arguments put forward against it are disappearing.

• Cost – The cost of real-time medical-grade sensors has dropped exponentially over the last five years. And for professional sports teams, where billions of dollars are spent each year, the costs are a pittance.
• Size & Weight – Sensors and devices for athletes must be almost invisible and weightless, as well as flexible, durable, and impact resistant. Medical grade sensors today are smaller than ever, and their weight is negligible – especially if they are incorporated into clothing.
• Interference with performance – Today’s medical grade sensors can be easily incorporated into the player’s uniforms and have minimal impact on performance.
• What they are measuring must be accurate and actionable – Devices already in use are measuring over one hundred human metrics, including heart rate, metabolism, stress load, core temperature, and physical impact from trauma. Researchers are forging ahead, designing devices that will be available soon to more accurately measure hydration levels and deeper aspects of physical stress and metabolic function
• Player privacy concerns – Many argue that understanding an individual player’s performance stats, physical challenges, and recovery times could be used in contract negotiations, trade talks, and performance incentives. Just as in healthcare, some privacy regulation (like HIPAA) needs to be in place and enforced.

Sports teams are quickly learning how wearable sports technology can improve their team’s performance and save players from injury and illness. But we must take advantage of today’s technology to better protect these elite athletes during the game. In professional sports, where billions of dollars are spent annually, the cost of implementing real-time, in-game monitoring for all athletes is a pittance. And as we experienced on Monday night, it only takes a few seconds for it to stop being a game—and start being about life and death.